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'FO THE CLERK OF THE CIRCUIT COURT.
Sfi. LUC 1 E COUNTY, ~.-I,O~A; .
• ~ .
9'~is is my declaration of Domicile and Citizenship is the State of Florida that I am Shag this day in aooordanoe, and is
_ conformity with Section 2?1.1?. Florida Statutt:. _
I vess formed a legal resident of ~j -S s H ~ ~t ey ~n •I - ind I ~ -
((St7l IStatal
rrsided at a~s~ ~ r/ •c ~ ~
S_._~~' ! . However. I have changed my domicile b
IStrset and Number)
and am and hsve been a bona Sde resident of the S4te adFlorida aiaae ~4 ~ _ day a[
• ..19.____L_~ uid I reside at ycS'~ 7 S. lu j w a ~ t
(Strad dad Nnmbesi
~~r7 SST ~ tc c: ST. l.alC 1 E County, Florida, ~
ttstyl
and this statement is to be taken as my declaratioa of citizenship, actual legal residence and domicile in the aiase of r
iorids.
IF FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAO PURPOSES,
CHILDREN IN SCHOOL, Pt.EASE STATE PLEASE CHECKS
THEIR 'NAMES: !
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C a h •r P a l C aT! ~ r: n .cJ C t i` ~ s
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- ~9i9 AtJ6 20 PN 2~ 28
ST.Ll~I N P ETRA A.
aEwc catcutt c~
R&t~RO VER1ftE
I FURRTHER CERTIFY that I will register at my local address schen the registration books reopen, dad comply with all
ether requirements of a legal resident of this Stale.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
T_ U C I E .County,
_ lCit~?
r~orida, permanenti~.
INamt)
tL/S ? S wl . /i''.e _
(Addrasal
orn to and svbsenbed before me this a C day of ~ ' ~
. , ~ _ ~ y~
; : <
ROGER P017RAS, CLERK OF CIRCUIT COI.~T ~,'`~""'~~"jj~, ~ . r
ST. LUGIE COUNTY, FLORtUA ~
:moo`°''~~ ~ s
vy~ ~ti~ tl.
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