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FD THE CLERK OFTHE CIRCUIT COURT.
S~. L UC 1 E COUN1`Y. FLORIDA: ,
4'his is my deeLration of Domicile and Citizenship in the State of Florida that I am Bing this day in aocordaace, and.
_ conformity with Section 222.17. Florida Statutes.
I was formed= a legal resident of I`tauae?t uelc _ C ~ ~gtZn _ and I '
(CitT) IState~ '
resided at ~ !?~+!?*+~Y s.~.~nort g~~ s p;~r,~„~ s Fla - Ao~vever. I have changed my domic~"Ie to
tStreel. and Number)
and am and have been a bon: fide rrsideaL of the State of Florida since Au¢. S 8-~.IS?n day of
19._,_~ and I reside at
19treet and Namberl
• ~ ST. LUC 1 E - County, Florida. ~
tcxttil !
and this statement is to be taken as my declaration of citizenship. actual legal residence and domia7e in the State of Florida.
IF FOR THE PURPOSE OF ENRO!lING IF FOR HOMESTEAD PURPOSES j
CH1~lOREN IN SCHOOIr PLEASE STATE PLEASE. CHECK: ~ ~
THEIR NAMES:
• Terri Lynn Merithew
~ ~
RE t~to
RA~~•
CW~tT
l~fERif1E0
I FURTHER CERTIFY that I wdl register at my local address when the registration books reopen. and wmply with aD
other requirements of a legal resident of this State.
1 FURTHER CER'T'IFY that I have no intention to return to my former domicRe; and I intend to remain in
T. U C I E _ County,
_ icily) .
Florida. permanenrl~. -
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Sworn to and sub;rncribed before me this day of
.79
ROGER POITRAS. CLERK OF CIRCUIT COURT
-
ST. LUG I E COUNTY, FLOR TDA
;
AY: -
' EPUTY JERK
f ~ ~ BOO~J~~ PAtiE~ ~ -