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Declarat~on of Qomic~le and C~t~aensh~p ~f :
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TO TJl6 CI.FItK OF TE[F CIRCUIT COURT. ~ 1
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ST. LUG 1 E Cpvt~rry. Ft,4RIDA: ~
This is my deelaration o[ Domicilo and Citizenship in the $tate of I~'lorida tlu?l I am filing thia d~y ia aecordanee, and in
conformity with Section ~12.14. Florida Statutes.
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I wu tormerly a Ic~;u1 resident ot v~ ~ !
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/ lCitr) 15~ate1 ;
re.idcd at _,~-Z ~ ~ G- / . However. I have ehanged mp domicile to
(•Street and Numbcr) ~
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and am rnd Aave been a lwns tide msident ot thc State of Florida since day ot
S/f~~-~ c ,e ~
.19 , and I residc at d2 •
lStreet and IZrmEer) ~
iC'7` ~57.- vc ST. LUG ! E cow~cy. F7oriaa,
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nnd this s!atcment is to be taken as my declaration of citizen~hip, actual legiel residenre and damicile in tho St~?te of Florida. ~
IF F'OR THE PURPOSE OF EMROLLING IP FOR HOMESTE/.0 PURPOSES~
CHIIDREN IN SGHOOI~ PLEASE STATE PI.EASE CHECK: r',' ;
TNE IR t~AMES: ~ L_~
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` FIIED ANC KECOR~EO
ST. IUCIE COl1MTY FU.
F.OCIR ?O~TRl~S
~ ~ ~ix CIFCUIT CO
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- OcT 19 9 i9 AM'i6 ~
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I FURTEiER CF.RTII~'Y th.~t I wiU rc ister at m la.:al addrsss when Lhe rc ' tration books reo n and com 1 with all ~
fi 7 S~ Pe • P Y ~
oiher rcqLirements of a Icgal resideni oi lhis State.
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I F1lRTHF.Z CER'i'IFY thxt I have no intention tn return to m~ former domicile, and I intend to remain in s#
T U C i E _ County ~
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Fiorida, pcrmanenti~ .
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Sw•orn to snd subsc.ribed 1x•forc; me this ~ day ot ~ ~!J C~~ f
- l~ ~(~,q~"' A.D.19. 7 8 r ~ I
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ROGER POITRAS, CLERK OF GfRCUtT COU2T
ST. IUCiE COUNTY, FLORIUA ~ ~
BY: ~
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~PUrtr ~enx ~
~ ~ 296 F~~E 9~~ r.
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