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Decfarat~c~n of Donnicile and Citizenship
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TO TAE CLERR OF THE t~RCtIIT OOU$T.
ST. t.UC l E a0vrn'~t. FIAaID~:
This is ~ dedsra<ioa d Domidk sod ~ tM Sots of Ffoeida tbst I am Olb~ tMs dq b aoooedaoai. sad b
oootaanigr wits $~etioo ~l.17. l9oeida Wis.
_ . I was l alspl r~esideot d asd I
. tG41 (8taa1
resided at Hawwer. I baw ehat~ed mT dasidie to
eV NeniRi
and am and haw been s boos Ode resident d Cite $tate_d Fioeida sines ~ dsT of
i>I_~ and I reside at '
. llle~etaeiNeoDeel
ST. L i E
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and this stat~me~ot is to be tapes as ep declaration d . adaal leEal reeidsaoe and doaddie in tbs Bests d >?lasida. _
I F fOR THE PURP08E Of ENROt.t. ING I P., s:OR NOMESTEAO PURPOSES,
CHILDREN tN BCMOOI, PtEA8E.8TATE PLi:ASE CN~CK:
THEIR NANE8t
` ~ FE6 •4 ~ 12~ 56
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REtdlt9 VERtf TED -
I FURTH>sii CEAT.Q+'Y thst I wID st e4f beat addeess when the reoa booms reopen. and oompy with a8
other regniraments.d s kcal reaideat d this State.
1 FURTHER (RATIFY that I hs~e no imteatioa to return to focrosr and I intend to :emaia i,
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swoca to and snb«ribed below ase this ,L_ dq d
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ROGER P!3! 3R!!S. CLERK OF C RCUI T c~lRT
ST. LUC 1 E COUNTY, F1.OR t OA r
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_ EPUTY t.ERK '
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