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» i TO TE[E CLERK OF THE CIACUIT ~OURT. • . • ~
• ST L UG 1 E COUNTY. FIARIDA:
• '1'Ais b my decl~r~tion ot Domicile and Cttlseaship ia tlie State o[ Florida th~t I aca Cdina tAis day in aetocdat~ee. and in
con(ormity with Saction 22.''.17. Fbrida Statutes. .
~ c r/E s T~ /Q _ N'~rv _ 1/'~ ~P h! .nd I
I rraa to~
*1~ a kgat resident ot 1~1 IS 1
. • However. I bave chaaged m~? docaieilc to '
resided ~t . Isee+~t ~ad Nevbart
day ot
and am and havc been a bona fids re~ident ot tho State ot Florida sinee ~
.19~. ~ I~ide st a~ b~~ S ~ ~r D r'D wN ~i~
. C . ISti+~t snd N~inb.rl
ST . LUG 1 E Couatr. Florida. ~
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I~c~1 '
~ad this statement is to be taken as my declaration ot cilizen~hip. actual kgal reaidence and domicile in the State ot Fiorida. [
~
. . ~
~ Ii' iOR HONESTEAD PURPOSES~
IF FOR THE PURPOSE OF ENROLLING ~,~E~gE CHEGK: ~ ~
CHILOREN IN SCHOOL~ PlEASE STATE
• THEIR NAHESZ
~
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~
' ~ =T~LI
CIE COUNTY ftA.
ROCER POITRAS
• Cf.ER+c CIRCUIT COU
~_'~c'rJ
~
' Aue 18 fI 27 AH'T8
41~it~93
1 FURTHER CFRTIFY that I will register at my loca) address when lhe registration books reopen. and comply with all
~ othcr requiremcnis o! a kgal resident ot this 5tate. -
I RTIiEZ CFltTIFY that I have no intention to return to my former domicile. and I intend to rem~in in
~ _ ST L U C 1 E County.
i
~ • lCic71 - ~
Fbrida. permanc~ti~ .
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l /~il~ r'r1 rn/y i
(llddros~) , i
d~y oT t D.~ T.~ T~ y^~~ :
e.. Sw•orn to Rnd subscrihcd betore me this ~
~ . A.D.19. 7 8 '
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~ . CLERK Of
C IRCUi T COU2T~ ~
fiti, -ROGER P01 TRAS, .
~ i
~j ST. LUG 1 E COUNTY, F l.Ok 1 UA ~
~ •
BY: ~
~ EPUTY LERK ,
~ . ' .
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' ~ $OOK~ t'~ ~
r Ari~ FY?M'~~ .
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