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, Declaration of Domicile and . Cit~~enship
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TWs b m~r d~darstioa ot Domicib aod Citt~asbtp iA tM 8tat~ ot FIo~1da tAat I am Hiio~ thfs ds,p ia aooo~dana. snd fn ;
ooatormier ..tch sacfou 222.17. b'foeida Stat~t~s. ,
I wa~ ~ M~s! ewid~at d 1~~"1~~-~ , aad I
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nsid~d at ~ Howrnr. I Law ei,anpd nqr do~aieil~ to
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aad am and haw b«a a booa 8d~ raid~at ot tM St~ oi FIorW~ ~iaa ~ da,~r ~
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-7'~_ ~.~l~ ~ t~ ~ ST. LUC 1 E couac~. Fbcids. ~
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aed thb ~tatem~at b eo b~ tak~n u aU dieLneba o~ dt~enship. aetwl ksal ewideaa aad doa~idM ia th~ 3tat~ al Flo~ida. ~
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ii fOR THE *UR'OSE Oi ENROLIING I~ ~OR MOMESTEAD PURPOSES~
CNI~OREN IN SCMOOL~ P~EASE STATE rLEASE CNECK: ~ ~
TNEIR NAMES: ~
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- • LED ANO RECORpEC :
y IUCiE COUNTY Fu ~
1lOCER PO~TRAS ~
RECORG YElIRFICp
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.Map Il 9 2~ AN'71
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I FtJKTHER CERTIFY that I w~71 ngister at tn~ local address ~rhea tbe ngistntion books raopea. and oompl~ ~rith all
other requiremeats o[ a kgal resident oE tbis State.
CER1'IE'Y that I have no iwteatba to e~turn to m torn~er dosnieik. and I intend to nmain in
.~,c.~c'~ , ~T . L ut ~ e . Count~,
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F'l~orids, per.~manenc;,-.
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Sworn to and subxribed betore me this day ot s
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. A.D.19.17 - *
ROGER POI TRaS. CLERrc OF C IRCUI T COI~tT ~
ST. LUG I E COUNTY, f ~OR 1 UA ~
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UTY LERK ~i~ ~]L~ ~
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~ ACO Form ~1 ?2