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Declaration o~~on~~ci~le and Citizenship
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TO T88 S'FATS AND (~UUN1'Y TAY ASSS8l301I, ~•,
dl- '~~'' apUNTY, lZABIDA:
This is my decLration of Domidle and Cltisenship in the State of Florida that I am filing thin day in
acoordanoe, and is conformity with Chapter 222, Section 222.17. Florida Statnt~.
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I was formerly a legal resident of-~~~~~~--- ------_ c ) _.~
. _ 'ifi let ~L 7ai~J~QLt~L~=fin ~!_:_7 -----.-----. Iio~ever. I have ct~s~ ~y ~'~"~"°
and I res~aea :t1..___---- ---=-------------~S~wt sad Nam~bes) U
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to and am and have been a bona fide resident of the :State of Ftar~ sip------- -- ..~ '
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and beside at_ ~db- -----'----------"'--____------
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.,~,t-1,~ `•t/~LCi°.~ ~ _!~..~~~%GC~-v - --------~~~'~ P7orida,
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and this statement is to be taken as my decLration of dtisenahip, actual legal residence and domkUe in
the State o! Florida.
ttInwrt dse ~ t =~ sw.l- as saM a~_ _yrop~st~r ~ a °ri~be~ni~hment ad emnlo7m~aL ~t
tora~r dove3l•. ~d a~ !~ to ns~~ doanle~u. P~~
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" ~`~' -~~_'~.~~ ~~~~ _~ 136! JAt~ 12 PM I: 54
---,, ~n~, ~,,,.•~' •~• ROGER POITRAS. CIERK M~
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•t==~:~~~_'"' ~ ST. IUCIE COUNTY, FIORIUA
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T tp-r ~ATLiY~!A /?Fiiiititi~v that i will re~riater !Et ~ `kcnl _ wheri the registration books re0~pen,
}.• M !. fw.ew!w~•1w ~ 8 ~~ ~~~e~_=fib lie i3~ ~~u.
a~`Q ~~ ~Z~ ~~ V~~Q~ 1bij~iY V.a.~r:..~ iii is ~~~_ - ~- --_
I F'LTRTHEIi; CERTIFY that I ?save no intantit,~ to ratnrn to at1 former domicile, and I intend to remain
~ •~.~i~ ~~~Gt~%e~ - ~ •~~ _Connty, Florida.
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