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To r~ir: CLF:ItK UI~'T1iE (`IRCUIT COtJ1;T, 4U1~7S~,
ST. LUC I E C.OUNTI'. FI.ORIDA:
This is my declaralion o! Domicile anc! Citizenship in the State ot Florida thal I an~ (iling this day in accordance. ttnd in
contormity v?ilh Section 2:N'.17~ Florida Statutcs.
I v?•as tormerl a Icgal resident of j'k l N~~' ~ ~ N~~ N~ and I
r r f~ IC" yi (State)
resided at ~ ~ ~ - ~L.GL~ La /1~~it~t , Now•ever. I have changed my~ domicile to
(Street ~nd Number)
and am rnd have been a buan Ccte cesident utthe Statc of Florida since dey ot
_ ~ 1911~. and I residc st
lStroet and Numbcr)
ST . L UG 1 E County. Florida,
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and lhis statement is to be taken as my declaration o[ citizenship. aetuef lega) msidence and domicile ia the State of Ftorida.
IF FOR 7NE PURPOSE OF' ENROLl1PtG IF FOR HOHESTEAO PURPOSES~
CHIl~REN !N SGHOOL~ PLEASE STATE PI.EASE CtiECK: ~
tHEiR NANES: •
S~.-~ ~ r2 ~ ~ /
t~~z~,~~
. iT E COUNTY Fia. _
ROCER p01TRAS
. ~~x ~'~CUIT CO
- r,~_,
I II za AN'7~
401'~,Si
I F'URTIIEK CERTII~ 1 tt:at I will registr.r at my local s+ddress w•hen tF.e registration books reopen, and comply with all
other require~nents of a Ir~al resident of this State,
I URTiIE CERTt 1C~t~at I t~a~•c~ no intentron to reiurn to mp farmcr domicile, and I intend to rema~n in
~T ~ ~ ~rZ ~L _ . ST . ~ U C I E . Coa^ty.
ICityl _ -
Florida, rcrmancnti~ .
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u~~crihcd bcfvr~ mc this tia~• c~f
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