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TO T11E CI,EItK OF THE CIRCi111' GOURT.
ST. lt1C 1 E COUNTY. FGORIDA:
This i3 my declaration ot Domicilc and Citizenship in the State o[ Florida tha! 1 am filing this day in accordsncc. and in
conformity wilh Scction 2:.'2.tT, Florida Stetutcs.
I was lormerlv a lega! resident o! ~,.1 ~i f~ end I
~ tcicr) (St.te)
resided at ~T, ~ £1 .}Iowcver. l hsvo changed my domicile to
(Street umberi
and am and have bcen a bons Cde resident ot the State oi Florida since .~~~,_T~ f j i r~ ~ day oI
~f J C
~ ~ .19__._;L,_. and I reside at ~
~G'" ~ ~JL// )I .'S F ~I
(i ~
_ _ , (Steret and Numbe~)
ST. LUC I E County, Florida.
ta~>> '
And this statemenl is to be tnken as my declaration ot citizenship. actual legal residence and domicile in the State of Florida.
IF FOR TIIE PURPOSE OF ENROLLING IF FOR HOMES7EAD PURPOSES~
CHILDREN (N SCHOOL~ Pl.EASE Si'ATE PIEASE CNECK: ~
tHE IR NRFtES2
=T• ~{ICIE COUMTY FLA.
ROCER PpITR~S
CIFQK C'RCWt COl1R ~
. vcorciED
- ~ Mar 3 10 s~ QH'ZR
402038 ,
I FUtiTIiER CI~:RTIFY that I will rnRister at my local address when the registration books reopen, and comply with all
other requirements of a tegal resident c~t this Slate.
I FURT1iE~ F:RT Y, that I have no intrntion to return to my [ormer domicile, and I intend to remain in
_ ~~t'4F ~ S 7_. L U C i E ~ Coun. y. .
lCity) .
Florida, pcrmanenti,~. ~
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SH•~rn to and s~l,s: rihed hrlorc mc this day of ~ ~ U
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R(1!'ER_ PO_I TR/:Si_ C! F~FZK C IRC,iIt T COt~2T
ST. LU~ t E: OUN7Y, f t_n'i 1 U!1
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