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ueciara~io~ a or uo~ illc~~e ana ~;<i~~zer~~~ ~~N
' ~ 4'~01'~4
TO THE t~.ERK OF THE CIRCUIT COURT. .
STS LUC I E ppv~y. ~,p~A;
~ `;This is m7 declaration a[ Domide and (~itiseaship is the Stats of F7o~ida that I am Lunt this day in aooor+daaoe. and k
_ conformity with Section 222.17. Fbrida~~ ~~S4)) ~
- I was fob a legal resident o[ ~ Cy~~ ~ and I
~ / " ~ IQt71 . ISesW
resided at a G J ~l~ E S ~ - However. I have changed my domia7e to
IStnd and N~Da:I
and am and have been a bona Sde resident os the S4Le of Florida since / ~ _ day d
19~ and I reside at ~O ~ ~~2/ ~yP
J1 ~L 18tr..t ud N®b.r1
%jf'l~ y I y9gC ~/l/~S / ~ ST. LUG 1 E County. Florida.
• lCttil
and this statement is to be taken as my declaration of citizenship, actual legal residence and dominle in the State at Florida.
I f fOR THE PURPOSE Of ENROt.L LNG I f -FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL., -PLEASE STATE PLEASE CHECK:
THEIR NAMES:
i
FtlEO ~M UEO
51. L'JC'! ~ FLA.
f
' T 'uRT
RE~~
SEC Z~ ~ ~ 41 A~
~'I ii
4701'4
i
I FURTHER CI~'Y that I will register at mT lonl addrns when the registration boobs reopen, and oompiy with all
other segninements of a legal resident ad this State.
I FURTHER CERTIF7C that I have no intention to return to m_v former domide. and I intend to remain in
- T. U C I E _ Coung.
It3t~1
Florida. permanenti~.
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a oC 4 .:r.. c~, ~4 :'t f 3 ,Lti 1 ~(C LC-_,
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` ~ ~ (Addrs~sl i
~ Sworn to and snbs~'bed before me this a day of ~G'O -~~/2 / i/Y ~~J . ~ ; ~
C e, tit ~ e ~ A.D.19_. ~ C=fi rI-R s M~~Tf~y<~ E Ti
S 3 3 5~ 1 ~5~
.79 ~
ROGER POITRAS. GLERK OF C iRCUI T COl~2T T~~
ST. LtlG 1 E COUNTY, f LOR 1 DA •
- ~
BY:
EPUTY I.ERK „e~~ arM