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Declaration of Domicile and Citizenshi
P
TO THE CLERK OF THE :CIRCUIT COURT.
ST. LUG 1 E COU~y, ~,O~A;
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This is my declaration d Domie~7e and Cttiasnshtp in tM State d Florida that I am B1iag this day to aoooedaaoe. and in
conformity with Section 222.17. Florida StatutasM,.
I was former a Eegat resident d 1 r t l~ ~ Y 1~ ~ C N~ y'+/ ~ P and I-
resided at ~ ? ~1kOtAI a Dtri y~ 1~'' _ However. ` ~ .
tsawt and Namb.N p, I haw changed nq domia'le to _
and am and have been a bona Sde resident d the State d Florida niece DP C • ;O • ~ 9 ~ 1 day of
19_ -andIresideat ~STAh L~00 SlN~L~ 1/~Ah ~Y~V~
l lStrNt aadNaa+bsd
~oY 1. ~i art e _ ST. LUG I E Counti.lF7orda. -
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and this statement is to be taken as my decLrstion of citiseaship. actual legal r+addenee and domiede in the State d Florida.
I f FOR THE PURPOSE Of ENROLLING i F fFOR iiviyESi EAO 'rv:aPvSES
CHtLOREN IN SCHOOLa PLEASE STATE PLEASE CHECKS
THEIR NAMES:
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I F[1RTHER CERTIFY that I w~71 register at my bcal address when the registration books reopen. and eompljr with all
other requirements of a legal resident of this State.
I FURTHER that I have ao inteatioa to return tom former domirde. and I intend to amain in
u c - County.
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Florid:. permanend; .
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- 1tIC RECQROCO
CWNTY.FUl. L. ' ,
,,~~.~Iltify~{~~ 1R POITRAS
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$we and subscribed be[ore me this ~ ~ day of , N'f'r/a~ . ~ 3 ~b ~
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GE POITRAS ERK OF CIRCUI f COt'dRT 1. o z 5 f
ST. IE COUNTY, FLOR1 A - ,
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EPU Y IERK
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