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Decl~ra~~on af [:~mic~i~ a~~d C~~iz~~~h~~
~rc~ Tiit. s-rn~~f: n~tu c~~u`~rY ~~~x n~s~ sst,~~. 26303
St~.Lucie-'----`__CUU?~l'Y, I~LORIU.'1: 2
"Il~is is tny cirrlaration of 1)omicilr and (~itii.•iichi~~ in tl~~ Statc ~~f I~lc~rida that (:nn iilin~ this d.iy it~
:Il;l'UIliJ11Cl', ~liili iii ~:l~iii~;----'•`. C..~:^•: 1~~ 1? ~i~~ri~lv QtnfU[C~_
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1 was tornuriy a Icgal rrsidcnt of _,~~R ~~~~i_-~
~!t_--_ _ h.~ J~-
- , ~ and 1
(c~tY)_ (slale)
residrd at _~~,.~___~dI A~~ 9~~- Ho~~~c~er, 1 have changed my domicile to
• ~ (Street and Numtxr) ~
T-`'~
and am and have been a ix~na i'Kl~• resi~ltnt uf the Stair uf Flc~rid~ since _1 S day of
now
--y~-. o , 19 7--.3_, and 1 /rcyidr at _ 8 ~ Z v~.-, o •L ~ /31
(Street aad Num )
_~D z f' S t ~
u t St. Lucie County, Florida,
(CllY)
and this statement is to be taken as my declaration of citizensl~ip, aclu~l legal residence and domicile in the State
of Flarida.
(Inscrf hcre any {+rrlinrnt faHs, sucA as sale oi property or twsir.ess, or retinquishment of employment at focmer
domicile. trmoral of family to nea domicik, purch~sr of home, etc.)
Entering children in school: n a.
~ ~
Purchased home in Port St. Lucie and am no~ a per.aanent resident
FILEO AKp RECORDED
St_ LUC1F CQ~~yN F
BOC~R POfTqAS U- l
. CLERK Ct~CU1T COURt ,,,,~~!!l
pF~~~D YE~tF1E0 MI -
-•--..._j~
'SEP ~ II 36 AH'13
~'6~432 - f
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! I FURTHER CERTIF=Y that 1 will re~i~tcr at my lo~al address wfien the registration books reopen, and
' comply with ail othcr requiremenis of a le~al residcnt of this Statr. _
~
! I FURTHER CERTIFY that 1 ha~~c na intrntion to rcturn to my formcr domicile, and I intend to rcmai~i in
, . ~
~ P v S ~ • ~ ~ ~ -s~- - st . Lucie
, County,
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k Sworn.'7 srritnd ixfc~rr ~i~c ti~i~
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~ ROGER POI"TRAS, C.~ R~ CIr~Ciil"t CGlii;T
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