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, D~ciaratio~ of Qomiciie and Citizenship
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TO T~IE CLERK dF THE CIRCUIT COURT. . ' , - ;
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' ST. LUC 1 E CovrrrY~ FLORIDA:
TAu b my deelaration ot Domicik ~nd Cit~enaAip In the State o[ F'lorida tAr~t I am Ciling thts day in attordapce. and in
conto~mity with Section 222.1T. Florida Ststutes. '
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I wu Iorm~~l a Icgal nsident ot ~ ~ ~ ~G . c~ S ~ ~nd [
lC.~ts1 lStat~1
resided at l~l~~ S~ . However. I have changed my domicite to ~
(St++~t ~nd Nvmberl
and ~m ~?nd have been a bona fide resident ot th~ State of Fiorida ~ince °~`C day ot
~ ~ -19_~`~. and I cesidc at ~l r> .
4~~ 1Stne! aad Numesr)
~,pr-~ ~ ST. I.UG i E Counir, Florids,
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aad this statement u to be taken as my deciaration ot citizenihip. actua) legal r~sidenct and domie~e in the State of Florids.
Ii FOR TNE PURPOSE OF ENROLLING IF FOR HOHESTEAD PURPaSES~
CHILOREN iN SCHOOL~ PIEASE STATE PLEASE CHECK2 ~--I ;
• " THEIR NANES: . ~ ~ `
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f LED AM~ RECOROEU ~
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~ t~.IUCIE COUMTY F~A
~~(r~-s~ ~"~'Lr~=~_ RACER PQITRAS
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1 FURT~iER CERTIFY that I wil) register at my loc:il addresa when t6e registration books reopen. and comply with sll
othcr rcquirements ot a lc~sl resident ot this Statc.
I FURTI E:t C~ItTIFY that I have no intention to return to my formcr domicile. and 1 intend to remain in
~~;c.L-~ c~ , ~T . L. U C 1 E , County.
~ lCityl .
Florida, permsnenti;. _
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Sworrt to and sabscribcd brtorc mc this Z-~ dny ot .,,,1-;;~~1f~ ~ f-: 3~} S`U
~C . A.D.19. / p
ROGER POI TRAS, CLERK OF G IRCUI T COU2T `
ST. LUG t E COUNTY, FLO~'t tUA ~ ~ ' _
BY: ~ "
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. EPUTY LERK
~ ~ tl~x ~~3 ~ PA~~ .147
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