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'FO THE CLERK OF THE CIRCUIT COURT.
S'~. LUG I E COUNTY. FI,oRIDw: .
4•his is my dedaration of Domide and Citizenship in the State of Florida.. that I am flin~ this day in :coordanoe. and in
wnlorrnity .ritb Section 222.17. Florida Statutes. •
' I Was lormerl a legal resident of ~N nail I
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resided at ~ VO/~'>t /Ayeever. I have changed my domic~e to " '
(St~set and Numbez) ~j ~,j( •
and am and have been a bona fide resident of the State of Florida since d i~ da7 ~
_...19_~r / . and I reside at ~/a ~ ~~j` ~iI/f
• ($treet and Number)
ST . LUG 1 E County. Florida, -
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and this statement is to be taken as my declaration of citizenship. actual legal residence and domin'le in the State of Florida.
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IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~1
THEIR NAMES: ~ V
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I FURTHER CERTIFY that I will register at my Local address When the registration books reopen, and comply with aU
other requirements o! a 1ega1 resident of this State.
•
~ I FURTHER CERTIFY t at I have no intention to return to m_v former domicile. and I intend to remain in
~ T_ U C I E ,County.
_ ~ IC' _
~ Florida, permanenu;.
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RpGER POI7RAS. CLERK OF C 1 RCU I T COURT ~ ~ _
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ST. LUG I E COUNTY, FLOR 7 D _ _
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EPUTY LERK
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