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Declaration of Dorriicile and Citizenship
To Tx>~ c of TxE cn:cvrr ooultr.
ST. L UC 1 E apUNTY~ ~~,pg~A;
This b np deelaratbn d Domidla and t~~saship le tba State d >!'Iocida that I am ~ thin dy is aeoorda~oa. asd ie
eontaamiUr with Section JIm3.17. P'loeida Startu'taa..
I was fa a 1e8a1 resident d I
~1 I~ 1 ~L1~2//.~I~ and I
9 IGV) (etsvl
easidsd st Q ~ - AoweRer. I haw e_
banpd ap doa~ieils to .
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and am and haw been a boas Sde resided d tM 8tate d Florida aiaa ~'S dq d
1 .1l1.fQ~,. and I reaiae at ~ 54? T~~.,, ~
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~ ST. LUG i E Floes.
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and this statemsat b to be ta><ea as ml? declaration d eitisenship. actual lesal residenos and domiAe in the State d Florida.
IF iOR THE PURPOSE OF ENRO~LlNG If FOR HOMESTEAD PURPOSE8,
CNIt.OREN iN SCHOOL, PLEASE STATE PLEASE CNECK:
THEIR NAMES:
~tL.EO AND RECOROEO~
- ~ l.::CtC COUNTY."r! A.
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'T9 FEB 22 AM _ ~ : 36
. CLEf~F. CtiiC::tT ;1L'RT
I FURTHER CERTIFY that I w~71 register at mir local address when the registration boob reopen. and oomph with aU
other rsgniremeats of a legal resident d this State.
I F'tJRTHER CERTIFY thst I baw no Intention to return to ~ former domidl4. and I intend to remain io
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tom) - - - - . Countt.
F7orula. permanensl, .
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Sworn to and subscribed before me this . a day of
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~tOGER POI TRAS. CLERK OF G IRCUI T COUtT
S~. LUGIE COUNTY, fl.ORtOA
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. EPUTY t.ERK S~JO~~ f~i~~21~
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