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TO THE CGEItK OF THE CIRCUIT COURT,
_ ST t L UG ! E Cput~'rY~ FLOR1llA: ;
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This 1~ my declaration ot DomJcile ~nd Ciliacn~hip tn thc Stato ot Florida that I~m C~ling this day in accordanco. and in (
contormity with Section 2~.17. FloridR Slatute~. ~
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I ~r~s tnrmPrlr ~ kgal rcaident ot ~ , . ~ and I
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cesidcd ~t ~ 7~ S ~_,~~,t~ . Howevcr. I have ehanged my domicile to
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and am ~nd heivc becn a bona Cdc resideet ot the State ot 1~'iorids since dsy ot ;
r ~ 19%rg - and I reside at S j
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(Str+~t and Number)
_~z~ ~~!:,~~~J ~ ST. LUG I E County, Florida. '
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and this statement is to be taken as my dcclaration ot citizenship. actual legal reaideacc and dortucile in the State o[ Florida.
IF FOR TNE PURPOSE OF ENROIIING Ii FOR HONES7EAD PURPOSES~
CHILOREN IN SCHOOL~ PIEASE STA7E PLEASE CHECK: ~
THEtR NAM~S:
_ •C.' rra ~ ~ .C~ ~vG-t
, AOGER FO!TRAS ~A. .
CIE~cK CIRCUIT COU-~
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~ AL~ 10 3 2$ PH'T8
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I FURT~IER CER'I'IFY that I will register at my local address when the registration books re~pcn. and comply with a!1
ather reQuirements ot a legai resident o[ this Slate. -
I FURTHE;t CERTIFY that I have no intention to reiurn to my former domicile, and I intend to remain in
~ 5;'-_c-~ t~~ _ S T. L U C 1 E , County.
(Cit~f . . .
Florida. permancnti; .
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Sw•orn to and sut?scritkd beforo me this ~G dAy of _ ~c+~~ ~s~~ -
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ROGER P01 TRASL CLCRlC OF C I RCUI T C,OlA2T
ST. LUG 1 E COUNTY, FI.OR t UA •
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