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~ THE CLERK OF THE CIRCUIT COURT.
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,S'~. LUC t E covhrrY, FLORIDA: - -
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•-~i"his is my dee]aratioa of Dnmic~e a;?d Citiaership in the State of Florida that I am filing this day is accordance. and in '
_ coafonnity a-itb Section 222.1?, Florida Statutes. •
y I u form_
erly a kEal resident of t,(,~ j a 1S~ o. t - `Cgr`P~" T , _ ~ , sad I
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r r s;ded at _ S/ An ~n-h~ ~pC~.iQ~ • However. I have changed my domic~7e to .
(Street ud Numtet) -
e d Ens and have Brea a bona fide resident of the State of Florida since g-13 _ day oaf
_19-~andIreside at ~/~I ~f-'lm ,l3Prek RnceL -
is~et saa Nu~~~
_ ---~~aL~~_ ~.u C i P Y_ _ - _ - ST. LUC I E County, Florida,
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~d this statement 1S t0 be Lr3cen !S my drela; ation of atizenship, actual legrl residence and domia7e In the State of Florida.
IF FOR THE Pt1RPOSE OF ENROLLING IF FOR HOHESTEAC PURPOSES
CHILDREN IN SCii00L~ PLEASE STATE Pt.EASE CHECK: - ~ ;
THEIR NAMES:
~a.5~ k R~ c n r d I.t)nti~l I~ P-~'
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X419 ~IUG 2~ ~ -
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' - - ~LUC1A ~ C~QEO
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I : Iii{ii::i3 C ~i:'1-i:'Y t:;at I c-it1 regster r_t r;.y lo:,-:l ::ddress ~:•hen the registration h~ks reopen. snd consply ~.i`'s all
~ r:qui:er_.ents of a lehal msident of this State.
I FURT~R .CERT'IF'Y thzt I have no intention to return to my former domiuTe. and I intend to remain in
= T._ U C 1 E County.
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' fl ~ 1 I M .Be c~c l~ Rcl .
(Address) }
• ~ r-._d ~ul:_ -d t.~for-c.ne this / day of ~ ~Q,( -E y~~ : Pr" ~/(3~ . .j
'`~9 .
E - A.D. 19
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• t_tY I t COUi~1TY, FLG:21 OA - _ .•vv~
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~ ~ BOOK PAGE
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