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Decta'ration of Domicile and Citizenshi
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414953
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TO Tti~ C1.ERK OF TlIE CIRCUIT COURT.
ST. LUC I E CpUN'j'y~ T~`T,pRIDA:
This ls my declaration o[ Domkile and Citjzetuhip in 1he State ot Florida that I~m C~ling this day ta accordanee. and ia
contormity with Section 2~.17. Flor'sda Ststutes. -
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lCit~l tStab)
reaided ~t However. I have cl~aaged mr domicile to
lStre~t Num~t)
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and ~m and hsve been a bona t'ide resideat ot the State ot Florida siaoe dar of
-192.~. and I reside at ~l~Y c~n . CVl'~GY~~ ,~iGGIJ~
l3tnK ~ed Numeer)
- ST. LIJC 1 E ' co„acr. Florida,
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aad this stutement is to bc taken u my dcclaralioa of eitiunship. artual kgal re~idence and domieile in the State ot Florids. .
IF FOR THE PURPOSE Of ENROLIING IF FOR HOMESTEAD PURPOSES~
CHILOREN IN SCHOOL~ PLEASE STATE PLEASE CH~CKS ~
TNEIR NAMES:
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Ff~~ ~ND REC~RpEU
sT- ~UCIE COUM lr FLA.
AOGER ?OtTRAS
CI ERK CiRCUIt C URT
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I FURTIIER CERTIFY that I will register at my local address when the registratien boolcs reopen; and comply with all
othcr requirements,o[ a legal resident oi this State.
~ I FURTNE~ CF.RTI that I hsve no intention to return to my former domicilc. and I intend to remain in
'~.Ut~ ~~Z « , ST L U C 1 E . County.
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Florida, pcrmanenti; .
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' Sw•orn to aad subscribed betore mc this ~5 day ot '
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' ROGER POI TRAS, CLEFtK OF C IRCUI T C.OUF2T
` ST. l lJG I E COUNTY, F I.OR 1 UA ~ ~
5 8 Y: S,a.,.. aG, - ..G~,~,. ~
~ EPUTY LERK ~
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ACn }'urm 71 :^Z
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