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' i~~clara$i~~~ a~ ~~n~ic~~~ a~d Ci~iz~~ns~i~ ~ ;
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TO TtfE CLEItK OF TIiE CIRCUIT COUItT~ ~695
• ST: LUG I E ~pt1N'ry. FI.ORIDA:
, Thb Is mp decla~ation ot Domicilo and Citt=oe~hip tp the State ot F{oridu that I am Gling t~ia dsy in aaord~nce. ~nd in
eonlormity witA Section 22..''.17. I~ lorida Statutes. .
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I wa.+ iormerl a kgal reaident ot ~ and I
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~ ICk I
resided ~t ~Iowever. I bavic ehanged my domicilo to '
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and am and h~ve been a bona Gde resident ot the State o[ Florida aince ~ dpr
19 sad I nside at _.S~ r~
~ (3trwt aod Numberl .
~~?/?,G{ _ ST . l l1C i E- Councr. F)oria..
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and th~ sU?tement is to be taken a~ my declaratioa of citiun~hip. actual legal m~idence and domicile in the State ot Fkrida.
if FOR THE PURPOSE OF ENROLLING If i'OR HOHESTEAD PURPOSES -
CNIL~REN IN SCHOOL~ PIEASE STAYE PLEASE GHECK2 ~
THE IR NAHES: ~ ~
- ~ fjlEO ~116 RECOR0E0 ~
ii. LflCIE COUNTY FU. ,
ROCER POITRAS
CLERK CiRCWT COURT
. -crn_r. ~;f~~F1E0
DEC 6 3 as PN'11
3~95
1 FURTIlER CERTIFY that I will re~ister at my local address when the registralion books reopen. and compty with aU
other requiremcnts ot a legal resident of lhis State. ,
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~ I FURTNE • RT1F .that I have no intrntion to return to my former dom+cile. an~ I intcnd to remain in
I • ~ $7 . L U C 1 E • , County.
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~ Florida. permanenti; .
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S•orn to e~nJ oub cribcd bcforo ~~c th:s ~ day ot ~l ~
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~ , A.D. 19~7 A ~ y~ ( ~ • QU~
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~ ROCER PO I~S,_ClFR1: 0:~ C t RCU l T COIJ~~T
ST. Lll~ i E COU , FLGR 1[)A •
BY: ~yr,(~ ~
~ ~PUTY ICItY.
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