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D~ctara~ion afi Don~icite and Ci~i~~~~~~ ~~~ ,
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TO THE CLERK OF THE CIRCUIT COURT.
ST. Ll1C 1 E ~;puNTy. ~t,pRIDA; . '
This is m~ declaration oi Domic~7e and Citizenship in the State of Florida that I am filing this da~ in aocordanoe. and ia
conformitt witb Sectioa 222.17. Florida Ststutes. ~
I w~s lormerlq a legal r~esident oi ~'~ ~/~ k'~ E: _ ~L- aad 1
_ IG5t7) 1~'•.tafR)
resided at ~ 5 f-j ~ NFrN P~`~ l D~ , Howeves. I bave obangrd ~r domic~e b
(Street aad Nombe~ •
and am and have been a bona Sde resident oi tbe StaLe of Florida since ~ ~ dq ot
N6 v~'/h~ 19~' ,, and I reside it ~-~ .~ NE l•v ~r ~ T D~
(Street and lvumbarl
j ~ ~~ _F_/~~- F , ST. LUG I E County. F'ririda.
((St~i
and this statement is to be taken as mJ declaration of dtizenship. attual legal reaidence and damic~t m t~ Stath s-f ~ori~is.
" IF FOR THE PURPOSE OF ENROL~LING
CHiLOREN IN SCNOOI~ PIEASE STATE
THEIR NAMES2 '
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~F fOR HOMESTEAD PUR!'aSES~ -
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PLEASE CNFCK:
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ii~EC cKr ~~coF~u
Sl lUtiE CCU?lfY.ii :.
aoGi.R rOititn5 ~
CLERK CIRCL'tT CL-lt=~ -'
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I FURTHER CERTIFY that I w~71 register at m~ loca! address rahea the registntion baoks reo,~en. and eompl~ witb aD
other requirements of a Iega1 resident oi this State.
I FURTI~It CERTIFY that I have no inteation to return to m~ torn~er domic7e, rs-d I intead to remain in ,
i• ~ r i t~ rc ~ c '' S T* L U C 1 E (~iOUDt~.
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F'forida, permanenu~.
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~ Sworn to and subscnbed before me this .~- da~ o[
~ ~ ~ ~.D.. / 98/
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ROGE I TRAS, , ERK Of C IRCUI T COt~'r2T
ST. LUG 1 E COUNTY, f LOR 1 O •
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~ - BY:
~ EPUTY I.LERK
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~ /,~J~:.n fif) il %Z_'.i.! " i 7.t/`
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