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Deciaration of Domiciie~ and Citizenshi `r
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ST= LUC 1 E QpT~q,
7tiia is ap dedardioa of Doa~ie0a and pasarbip to tM 8tata of l9aeids taut I ad tbM dq is aeoordaooe, spd b
wltti BKtion !!dl.I7. !'toeida 8tatdar.
I was a Meat resided of ~ and I
resided at ~ Or'0 ~ l~ ~ - $o~wrae. I tun sV doasieAs fA
. IiltrMt eai l~Iarlrft
aad am and ban been a boos fide raideat oitbe &ate of Florida sioa ~ dp d
tee` ~ ~y •
~ ~ • 19!
a aed I swida a! O ./L
ST. lUG i E p~L,
tam
and tWs statem~t is to be takaa ar ~ deeLratioa d , aetwt leKal reddens snd doaoiciie to the &ate of Fioeids.
l i POR THE t'URf'OSE OF ENROLL IN6 I i iOR NONESTEAO PURt•OSE=,
CHILDREN I N s6H00?~ i'IEASE sTATE r•LEASE CHECKS r"-"""~
T,NE~1
R NANE s t - j„~,._--..J
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u~~ _e c~s~- 19~ FE6 19 PM 2 52
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. CLERK CIRapT COURj~
R136611i1 VfRIffEQ_.~
4'6496
I FtJ8T1~ CERTQ'Y that I wiII at aq toai address wbea t>te r+e~strstioa boob reopen, and oo~opb wits a>!
ottMr regaireaesats d a Mpt resided a[ tt3s titate.
I F1JAZ~t CEBTII+'Y that I bare ao ioteetioo to :slurs to a~ former doio~. sad I intend to :amain is
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1:'ioeida. permaoemar.
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sworn to and aubsrribsd before me this d aT d
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ROGER POITRAS. CLERK OP G RCUIT C0~3T
ST. LUCIE COUNTY, fLOR1UA
BYs
E?UTY LERK
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