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TO TNE CLERK OF TNE CIRCUIT COURT.
ST. LUC 1 E COUN7'Y. FLORIDA: ~
T'bIs b my deelaration ot Domki{e ~ad Citiseaship tn the State ot b'lorida thst I ua tUna this d~y iri ~c~ia~a. ~ud ia ~
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conionolty ~ritA Sectioa 222.17. F{orida StRtutes.
I wa tormerlY a 1egu1 sesident oi ~H~d/07' , D~/ ~ j
~ay?~ ts~ ~
cesided at - 3~ /C~ (~aLf.+tJ/ylO~E However. I bave changed a~r domieile to ~
lBteMt ~ad N~mbK1 •
atid am and bsve baen a bona C~de resideAt of the 3tate of Ftorida sinee J~ F~°T S~_ ~r
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j~'.r~A E~+C ig
~ J`_, aad I nstde at 3l-~ _So•c, ~.D R ~/.Ga G~
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p.t f S i. l8tewt a.d NamD«~) .
~ v~ ~ E . ST. LUG 1 E ~t~. F.lo~;d,~
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add this atatcmcat ta to be talcea sa tq~r detluat~oa of eitlzenshIp. actual kgal rasidence wd domicile in the StaLe oi Florida. 1
If FOR THE PURPOSE OP ENROLIING IF POR ~IOMESTEAO_PURPOSESi
CNILDREN IN SCHOOI.~ PLEASE STAtE PI.EASE CHECKS ~
THEIR NAMES: ~
~ YNJ~'xtiA /~ivN /yS,~c,L -
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fllE~ AK~ RECOROEC
ST.lUC1E CdUNTY FIA, '
ROGEn POiTRAS I
. ClEAR ~tKCUIT COURT ~
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S~ 8 l0 a6 AN'75
~ 316233
I FURTHER CERTIFY that I will register at my local address when the registratioa books reapen. and comply with aq
other requirements of s legal resident ot this State.
I FU c~ CEB~ that I have no intcation to return b my former domieiie. end I intend ta remain in
- 'f"'~v«' ST. LUClE
, County.
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Fbrida. permaneati; .
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Sworn to and su ibed before me this ~ day ot
A.D.19 -
ROGER P I TRAS~ GLERK OF C I RCU I T GOl~2T
ST. Ll1G I E COUNTY, FLOR 1 A
8Ys
T l R K B~~K243 ~13~~
ACO Fortn 7f •22
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