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TO THE CLERK OFTBE CIItCUIT OOURT.
ST. LUC 1 E OpUNry. Fi,ORIDA; - .
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T6is`~bgr dedaralioo e[ Domicltie and t~enship is the State d Dodds that I am ~s this d~ is aoooedana. and fa i t
. eonfatmistij with Seetioo 2?3.17. h7arida Statntas. _
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I was ~ a legal resident d ~ _ 11~ ~ ~/1CEi,/N/A• sad I =
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resided st 3 /b ~7/~l~/_~12 /~Q~- • - 8awawr. I haw e.hae~ged mf domieDe to
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_ and am and have been a bona fide resident d the State d ~'i since /S ~ Q ~ d .
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~.1! and I reside at • ' ' S
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~p~2rt S~: (~,t Q,~.E - _ ST. ~ LUG 1 E Connt~. Flo~ids,
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aud this statement is to be taken as ~ declaration d dtisenahip; adual legal residence and domidie in the State d 1:7orida.
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IF FOR THE PURPOSE Oi ENitO~LING IF FOR HOMESTEAD PURPOSESr
CHILDREN IN SCHOO<r PLEASE STATE PLEASE CHECK:
THEiR NAMES: ,
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I FtJRTHQt CERTIFY that I w~ register d mT local address wben the registration books reopen. sad eomplT with all
other regoaements d a legal resided d this State.
I FtIRTIiER CERTIFY that I have no intention to return to fairmer dom. and I mend to remain is
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Sworn to sad sabseribed before aye this ~ daT d ~ -
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ROGER ~OITRAS. CLERK OF GiRGUIT GOURT
_ST. LUGIE COUNTY, fLOR10A _
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