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Deciaration of Dornicile and Citizensh~p
~ro~c~~coF~c~ccn~rcouierr, 3?A314
_ST. LUC 1 E apt1NTY. Ft,ORIDAi .
This b mr deelantioa ot Domkile aad GYti~aship ia tbs 8tat~ ot F{osida tbat i aa~ tDin~ tbis da,~ in ~ceordsna. aad ta
eoatoeoni4jr w?it6 Seetjoa 22Z.1T. Floeida Statntea. .
I was i
n+~rl a kgal resideat ot ~~J~.~.~"J - aed I
tCk~l • lstst~!
resided at - r~ a~ - Howewr. I bavs ebat~ed aqr domieile eo
(eteMt ~d I~I~~.r! ~
aad ~ra aad have beea a bona Bde resideat oi the Stat~ ~ F'brid~ daa ~J' ~
19~ aad I e~eside at ~
tste«t d Nr~1
. _ ST. LtlG 1 E ~
~av~
and this statement is b bs tatea as m~? dec4ntioa oi ettizsn~6ip. sttna! kaal residenee and do~ieite in the 3tsts oI Fbeids.
IF FOR THE rURPOSE OF ENROI~ING Ii fOR HOMESTEAD PURPOSES
CHILOREN IN SCHOOI~ PLEASE STATE P~EASE CHECKS ~
tHE1R NAMESS
ST~iuCRx~~uNT~1r~f
~ .
. Ii06'c~ ~GiTRAS -
- CLEFR C: ;~IT COURT
RFCAR~ YrF.i{JE~
~r '1 Il s~ PM'l5
320314
~ -
j I FUR'fNER CER1'IF`Y that 1 will register at my loeal addres~ whea the registntion boots reopea. aad oomptp witb aA
' other requirements ot a legsl resident oi this State.
~ I FURTHER CERTIFY tl~t I have no intrntion to nturn to m~ toimer domicik. a.nd I 111LCDd to remain in
~ • ST . L U C 1 E _ County.
. l(St7)
~ Fbrida. permanenti~ . ~
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~ Sworn to and subsen'bed before me this a.r ot ~
+l ~ ~ ~ A.D.19 / J -
ROGER POITRAS, CLERK OF CIRCUIT COURT
ST. LUGIE COUNTY, fLOR1UA
BY 2 ~ P V ~ E R K - BOOK 245 PAGE13?1
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