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TOT~IE C[.F,ltti OFTEIF C[RCCtIT COURT. - , '
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^ ST. L UE 1 E ~ ~pvrr~y. FLORIDA: S
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This is my declantion o[ nornicile and Citizcn~hip in the Stato ot Florida that I am C~ling thi~ day in accorclance. and in
~ r, :~ormity with Scttion 22'r.l?. Florida Statute~.
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I~?u tormc~l a legai nsidcnt ot ~/V S ~ ~ ~
lCttrl l3taul
resided at ~ Z -S • S'f RAtF~ l2 O(j . ~ . However. I have changed my domicile to
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aod sm aad have beca a Dona fi~c resident oI the State ot Florida aince ~ 9 day ot ~
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p i? C~~t ~ Q!Z 19~ tnd I reside at ~-W d~ ? I d~~ SU C!! I~ OG ~
AN 2. ~
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l$t•eet and NuaiDsr) i
j~e~c~ ST. lUC i E
- . Cou:?ty. Flu~da, r
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arid this sUtement is to be t~ken at my detlaration ot eitizee~hip, actual legal residenee aad domicile in the State o[ Flocidn.
IF FOR THE PURPOSE OF ENROILING IF FOR HOHES7EAD PURPOSES~
CHILOREN IN SCNOOL~ PIEASE STATE PLEASE CH~CK: #
THEIR NAMES: f
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k 1 E URTiIEf: C~:r:TiF~ that I w-iil registe: at my lx~l address when t.~e rensir..tio:~ b:r~ks reopen. nr.d cvuip!y v•iti. .:t ~
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o_fiec teqeirctn^nts oi a le~el reside~! o: ihis SLzic. ~
I F'URTRF::t Ct;2TIFY t~.~t I h:?~~c no inter.tio: to tetc:n to my fo:m~r dorruciie, ai~d 1 in:cnd to rer~.:.ir. ia
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- - - - --j_ - - - - ST.LUCIE COUMTY FLI~
~ • ROGEi~ POITRAS ~
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