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Declaratie~n of Domi~ilo .and C~itixenshi .
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To~aa~coFra,aC~vrr. oacn~r.
5T LUG ! E apU~I~'PY~ FLORIDA:
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This is dseVratios vl Domieiis aad ~ fA tl~e $ta3~ v! Florida that I sn~ ~ this dsy ht aaoordaoeQ. asd la
oonlarmib with Seetioa 28l.IT. Florida 8tatatu.• ~ - - .
. I was i a MEsI rs of ~ ~ aad l~
resided at - f ~ - -
` ~ c8ra+ .t aid
t~ne.e1 ~ Howo~r. I ba~a ehaaEed ~p da~a~iA` to
iIId a~ a~ here heea a h0~! Bde repdiDt OBI t1N State 0~ T' lOrida i~pOf . O d~ a[ a
' ~ Li. •1 and I aside at ~ r~ C• ~ ~ ~ ~ f
ST. LUCIE
caa~ - cova4' h7oeids.
and this statemeat is to be takta as ~ dselssatfoe at dt~eaship. setnal ~ rrsidsr~a ar~d domi~a sa tl?e &st. of Florida. -
LP FOR THE PURP08E OF ENROLLING IF FOR NONESTEAO PURPOSESs -
CN I LOREN I N 3CHOOL~ • P<.EASE STATE PLEASE CHECKS
THEIR NAMES: -
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_ ~JAN21 PI~~04
- _ ~~~~E~~CA~~,,N~~D bE~~pp~~O--- -
- - '~R05ER ~TTY~.r'SL.1. -
. - - CLERK CIRCiNT T - -
~ KEGRR V[R!f IED
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- - - _ - - _ _ .4'73292 - -
I FtJR1'IIER CERTII~'Y thst I wal regular at mT bcal address w6~ the tegidration boobs eeapea,.and comply with all .
dt6er ragaue~ment! of a kgzi sesidaut of this Slats.
I FURTID,R CERTIFY--that I- have no intention to retwn--tom fa~merdoenia7e:.and-I 3nten_d to is~naiin is
t1CIE
lam) . County.
Flom. penmanend;. _ _ - -
g, COU~,~ - _ , -
~J f~,••....u fem., f
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Swrora to and snhsrdbed before me this daT of -
ROGER POli~2AS. CLERK OF CIRCUI T COtdZT
ST. LUCIE COUNTY, fL0lt10A _ _
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_ EPUTY LERK -
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