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l`0 THE CL>~RK OF THE C1ltCUIT COURT.
S~. L UC 1 E Courrz~r. F3ARIDA: ~ -
This is aqF decLration of Domiule and Citizenship in the State of Florida that I. am fling this day in accordance, and is
_ eonlormity .rith Section 222.17, Flarida Statutes.
I was formerly a legal resident aI ~-j ~ t Yet 1\e~ ~ ~ ~ ~ assd I .
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resided at ~ o`~ VJV1f\Si11 • However, I have changed my domiu7e to
IStseat and Nu>nDa~
and am and have been a bona Bde resident olthe State oiFlorida since _ ~ ,T~ dal of '
. 8
19_._._, and I wide at
1 Numbarl
• ~tr}- ST LUG I E
• County. Florida; i
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and this slattment is to be taken as my declaration of citizenship, actual legal residence and domia7e in the State of Florida. -
IF FOR 7HE PURPOSE OF EMROLLtNG IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, .PLEASE STATE PLEASE CHECKS
THEIR NAHESS ,4, _
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c9t9 1~L'G 21 Ald 9~ 21
FKEOA~~~I~~~pR~E~~~'~~ttUtU
_ ST~LOGER POITRAFLA.
CLERK CIR~CU~IT COURT
- RECORD YERIFic'0
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I FURTHER CERTIFY that I ws71 register at my Local address when the registration books reopen, and comply wills all
other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to m. loaner domicsle, and I intend to remain in
. T. U C 1 E ,County.
j - IC'ity]
Florida. pa~mancnsl;.
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Sworn to and subscn'bed before me this day ~
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- A.D.19_ 9 - f , -
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ROGER POI AS, CLERK OF G IRCUI TCOURT a-- .Yt~~ '
ST. L UC I E COUNTY, FtOR t DA : o • ti~ ~ ~ ~
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