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TO T1IE CLERK OF THE CIRCUIT COUIiT.
ST. L UG i E ~pU~y~ ~'I,ORtDA:
• Thi+ t~ my declaration oI Domicils and Citisen~hip io the State ot Florid~ thtt I am filing tfiis day in accordance. and in
to~lormity with Section 22?.17. Florida Stntute~. ~
I w~aa fa~ tnerlY a kgal teaident ot -~-l~-L+~L 1 n~ ~`~'L•, u,d I
o, ~ ~~~j;~ lCit7) lStat~! .
residcd at ~~tir%y'~"J- i Nowe~ er. I have changed mr domicile to `
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( t ~nd Nemberl ~
aad am and have been a bona fide resident ot the State o[ Ftorida ~inc _ ~ ' day ot
( ~~~s-' . 29~.,Z. and I reside at ~ .~~~Y~ .
" ~p~~~~= (3t»et ~ad I3umbet)
~~~l~G ~1 ~ ST, L.UC I E County. Florids.
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aad this statement is to be taken as my declaration ot citizen~hip. actual legal resideace aad domicite in the State ot Florida.
IF iOR THE PURPaSE O~ ENROLLING ' Ii FOR HONESTEAO PURPOSES~
CHiLDREN fN SCHOOL~ PIEASE STATE PLEASE CHECK; ~
THEIR NAMES:
tT~IUCIE COUNTY Fl~ ~
R4CER POITRAS '
. F~.R C~~t~U1T CCUn? Q R
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I FURTHER CERTIFY that I will regis:er at my local addrese when the tegistration books reopen, and comply with all
~ ather requirements ot a legal resider.t of this State.
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I T~E;i ER.TIFY thsi I av no inl~e ion to reiurn to my former domicile. and I iotend to remain in -
~Z~ ~Q~ ST . UC 1 E
. County.
• Cit~) . .
Florida. permanenti~ .
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Sworn to and suhscribed betore me this day of O` L/ ./«'C_L_~/J!-~~~-L~r ^
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ROGER POITRAS. CLERK OF CIRLU;T COUfZT
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ST. Ll1C i~ CODUTY, FLOR t UA •
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