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TO Tllt•: C[.H:ItK Ob' T11E C1ftCUIT COURT, .
ST . L UC I E COUNTY FLORIDA: •
This is ~rqr dec4ratiun of Domicile and Citizenship in the Slate of Florida that I am filing this duy id accordance, and in
conformity with Section X2.17. t•'lorida $tatutcs.
~ ~ G I'1 ~ i and I
1 was tormerl a legal resident of , . tstuel
tour)
resided at ~ ~ at(,}w IN S' : a o . However. I have changed my domicile to
(8tnet sad Number) .
and am and have beet? a bona tide residoat of the State o Florida since ~ 8A - - -day of
~~.3 ~S' -19 and I reside at °
~AN~~~'~ ~ V~
• (Stnst and Nnmber)
~ - r 7 ~ ~ ` _ ST . L UC 1 E County. Florida,
- . t(~71
and this statement is to be taken as my declaration of citizenship. actual legal residence and domieik in the State of Florida.
~F FOR THE PURPOSE OF ENROLt.ING IF FOR HOMESTEAD PURE-P-OSE~,S~,
CH 1 LDREH t•N SCHOOt., PLE-ASE STATE PLEASE CHECKS I l/ I
THEIR N A M E.S : i----~
• ' FtLEO .ANON R~CORI~~~
ST. LUCIE COUNTY.'fLA
~~rCORQ VERIFIED
- ~32'7s2
- '79 FEB 2 AM 9 : S9
_
RO':~I? POITR:.S
• CLERK CiRCUiT COURT,
i I FURTIiER CERTIFY that I w~71 register at my local address when the registration books reopen. an3 comply with all
~ other requirements of a legal resident of tbis State.
I FURT1iE~ CERTII''Y that I have no intention to return to my former domicile, and I intend to remain in
k ~ U C 1 E County.
,Zo ~i
P~.~Rc ~ t -
Florida, permaneml;. y S
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Sworn ltS
and subscribed before me this day of ~ c RL i iG
Y~C~•~ -3 3 ~
~ _
ROGER POI TRAS, CLERIC OF G IRCUI T_ COUR1'
ST. LUGIE COUNTY, FLOR UA -
• BY: +
~ EPUTY LERK ~
- ~ P 20.0
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