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TO THE CLERK OF THE CIRCUIT COURT, .
ST. LUG 1 E ppU~y FLORIDA:
This is'bgj d"eelaration of DomkrDe and Citizenship is the State apt Florida that I sm Sling this dsT is aa_ ooedanoe. aed in `
" eoniormit~ with Section 222.17. Florida Statute:. i
I was f
~ a kgai sesideut at ~N d~~G~ It ~
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andl
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resided at 0~ DLO Q.~.~ot~ ~ ~ l-t C hT 8ewerer. I have changed aqT dosoidle to
IStrs~t sad Nmab~u
and am and have bees a bona Ede resident of the Stage d Florida since ~ _ ~ / _ daT of
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2..._..19 , and I reside at ,.~y ~ ~C v A/ 1 f~/ D a ~
U t~
1 ~ L u G~ 2 - ~ ST. LUG 1 Eew.~.aaNoe~.e~
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and this statement is to be taken as m~ declaration os citizenship. actual legal residence and domie~e is the Stats a[ F7arida.
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If FOR THE PURPOSE OF ENROLLING - ~~IF-fOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOL., PLEASE STATE PLEASE CHECKS-
THEIR NAMESS ~ i
f9~9 SEP 28 P~f 12~ -26
FILED ANO ?~EC080i.0
- ST~LUCIE COWJTY.FLA.
OGER POITRAS
- - CLERK CIRCUIT CO n
R#100RD VERIFIEQ~~
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_ 460'716 .
I F[1R1TiEB CERTIFY that I w~ register at my local address when the registration boobs reopen, and ooraply with a11- -
otber requirements a[ a kgal residc~ of this State. -
I F47AT~li CERTIFY I ha ao intention to return to ~7 former domicile. sad I intend to remain in
T U c I E - Count~~
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Fbrida. permaaensl;.
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Sworn to sad sobsQr-bead befae sae this aaY d
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ROt~ER P017RAS. CLERK OF G IRCUf T COURT -
ST. LUG1E COUNTY, fLOR10A
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