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uecia~'a~~acb oY t~oci~~ci~.e ana V~•i~~e~~~i~~~
- 49532 .
TO TIIE Ci.ERR OF T1~ CIIiCU1T COURT.
- S'~~ LUG 1 E - OOUN'1'lt. FIARIDA: ,
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~ This is cep declaration et Domics'le and t~ssaship is tbs Sots d >r7oeada that I am SSas this d:, is aoooedaac+e. and b
. mafarmitj witL Ssctioa ?2Z.1T. Florida Statntss. n
r. 1. ~ ~ ~~C t aced I
- I wa: f
~ a legal resident of
- ptTl . 18em1
resided at - ~ However. I hays eh:aged ~ domia'le to
. 18er.d aai NawDsrl .
and am and Lave bean a bona Sde resident of the State otFlorida uiaoe ~ ~7 d -
19 - and I recede at '
lBtrMt aced Zi.sb.el
c~~ _ p.~-~2 _ ST. LUG i E CoantT.>:9orida. _
-
' and this sLtement is to be taken as mT daelaratioa of dtiunship. actual legal residence aced domiale is the State d 1:7orida.
I F FOR THE PURPOSE OF ENROLL. t'NG I F FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOLa-PIEASE STATE PLEASE GHECKt
THEIR NAMESt
~ ~
• f lE0 AMA -'aE0
~ S~.IUCIF . ~ ~ ~ ° FIA.
' CIEF? ' ._~~titi
RECOp_ ~ . z ~ •
~ O~c ICI 3 09 P1~'1q -
~ - ~ - ~
w~- - .
4.9532
P
~ 1 F[JRTIIER (~RTlF'Y that I w~ register at mT local address when the registration boob reopen. aced oomplT with all
other requirements a[ a legal resident ad this State. .
r I FURTHER CERTIFY that 1 have no intention to return to - m~ former domic:7e. and I intend to remain in +
- T U G E CountT,
~ _ t4's~)
Florida, permanend;.
_ ` ~~o~NTy ~ !
U:•
t= c G'~'" :
J + I
,1:~ - ~ amt)
~/a _
Sworn to sated before me tLis ~ ~ dsT of ~ i ~Ti el~C
. .79 ~ .
ROGER POITRAS. CLERK OF CIRCUIT COURT , .
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ST. LUGIE COUNTY, FLORIDA - - -
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• E P U T T L E R K ~OOX t~ PACE ViIJtJ