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. D~claration of Domicile and Cit~zensn~p ,
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~ TO TfIE CI.ERK OF TIIE CIRCUII' COURT. . 414,~;,q~ . ~
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ST. lUG t E CpUNTY~ F`~,pRIDA: ~
Tf?I~ ls my dcclaratioa o! Ik+micik ~nd Cithcnship in ihe Str?te of f~'lorfda that I am tiling th~+ day iti aceordanea. ~nd in
contormity with Section 222.17. Florids 5t~tutss. '
I aas io~ a lega! resideat ot 11 c~ L.~ ~ - ~'-~a. ~,i' aod I
. t~y) iStab!
trsidtd at ~;._1~,~ ~.,:r,,~~ . However~ I t~ave changed my domicilc to •
15trwt aoA Num~~) ~
aad un and heve been a bous Cde re~ident of the St;te of Ftorida siate ~ dar ot
-~~~s.~~ ,19Z~,. and I reside Rt ~`~~i7 ~Ca w,.'k~~~ \ L~-,., ~e
t7.`ca ~ P ST. LUG 1 Esc~c.~aNw~~
County. Florid~.
lpty)
and this statement iu to be taken as mr declaration oi cituen'sAip. actua) lega} re~ideACe and domicile in the State ot Ftorida,
If FOR THE PURPOSE O~' ENROLLtNG ~ Ii ~4R HOHESTEAD PURPOSEg~
tHII.DREN IN SCHOOI~ P~EASE STAi'E PLEASE CNECKi ~
' Y~HElR NAMES:
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iT.(,~I~~r ~ A
AOCER POiTRAS
. . CIfRK Ct~CU1T CO T
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' A~;r 4 ns PM~''
41499"~
I FURTHER CFRTIFY that I wiH register at my locaJ addrcss when the registration books reopen. aad complr with all
othcr requircments o[ a legal resident of this $tatc.
I FURT}IE~ ~GF.ItTiFY that I have no intrntion to relurn to my former domicile. and I intend to remsin in
~"i Y~ ~ti~_s.; ' ~ S T. L U C i E County.
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Fbrida, permancn~i; .
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- `'~c=~ IName1
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IAddreas)
Swocn lo and subscribrd be(orc mc this day of ~~~C. y C t~
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C~.,...._.r~ . ~?.v. ~s. 7 8 =
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ROGER POi~T~AS, CIERK OF CIRCUIT COUFtT ~ '
ST. LUG I E COUNTY, F I.OR 1 UA ~
E3Y t
EPUTY LERM ~ '
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BOQK ~93 PAGf' ~ r
AGU F'arm 11 ^'d ~
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