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TU Tt1E CGERti OF TllE CIRCUIT COURT. ~
ST. LUG I E CpUNTY, FI:ORIDA:
• This ts my declnration ol pomicile and Cilizeoahip ia tho State o! Floeida th~t I am Lling t6u day Ia actord~oce. i?nd in
eonformity with Sectio~ 22.`'.17. Flo~ida Statutea.
I~ru lornnerl a tegal nyident ot ~t~ - ~ and I
, lCtt~1 IStaW
resided at ~ However. I bave ehanged my domicJe to
Strs~t and NumD~d G~ .
arsd am and have beea a bons Gde resideat ot the State oi Fbrida since ~ dsr ot
.19~ and I ~estde at -
--T (S .od Nrmper)
~ ST. LUG 1 E Couaty, Florida. ~
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~nd thi~ stetemeat is to be taken ss my d~-clantion ot citizen~Aip. actual legat t~c~idence and domicile in the State ot Florida.
I~ FOR TNE PURPOSE Of~ENROILiNG IF FOR HOHESTEAD PURPOSES~
CH1LOREN 1N SCHOOL~ P~EASE STATE PLEASE CHEtK; ~
THE1R NAHES:
. ST~~
C E COUMTY FtA.
ROCEP. POITRAS
~LfRK C~RCUIT COURt
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DEC 1l 2 ao PN'11 .
3F~8681
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~ I FURTEiER CERTIFY thst I will regis:er at my local a33ress w~,en the regisLratiou booics reopen. and comply with cll
othe~ rcquircments o[ a iefial nsident of thi~ State.
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~ I FURTHt.:~ CERTIF'Y thst I ha~•e oo intrntion to retcrn to my foru:~r domicile, and I intend to remain ic
~ ' ~ S T. L U C 1 E Coueeiy.
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Flotida, pcrtr.aaenti~.
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