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432999
TO Tllr: C[.LRK OF THE: CII;GUIT COURT,
ST. LUC 1 E CAUNTY. FIARIDA:
This is my declaration of I)omicJe and Citizenship in the State of Florida that I am tiling this day in aceordanco, and in
conformity with Section 22.17, Florida Sta~tutes. ~ .p
I was former! a Mgal resident of T ~"'t v ~ ~ ~ - a 1~.~-- ~d I
--k# ICit 1~°I
residrd at G . Nowover. I have changed my domicile to
ISt?~ tad Nnmt»t) ~ /
and am,and have been a boas Cde resident of the State of Florida since _ ~S e ~ o C[ day of
' ,19,L. and I reside at ~ ~ ~ • ~ ~ ~ C ~ S ~
(Sued and Number)
c
?~-1' ~ ~ e ~Cc ST. LUC 1 E County. Florida,
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and this statement is to be taken as my declaration of citisenship, actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PI EASE STATE PLEASE CHECK:
THE
I~R~ NAMES2
.//a.~~~ ~~~he ~70~rSun
• FiI.ED AND~RECOR~~'
ST.~L~~oap VuL-'RIF EOLA~~
4;32.999
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_ - i~;~~~:.R YOtTQ..
CLERK CIRCUIT _~OURT
I FURTIIE R CERTIFY that I will register at my local address when the registration books reopen. and comply wish all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
- - ~ ~ ~ . ~ ~ ~ ~ ~ -County.
ICit~l
Florida. permanent!; .
~ ``1111?~~~j~~~
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. ~ Addreee)
Sworn to nd sub~crihrd before me this ~ day of ~ ,~°7 ~ ~ ~ ~C ~ ~~Q
" -
- , A.n. 1Q_ ~ 9
LERK OF C 1_RCUt T CUU~tT
1 ROGER POITRAS.
ST. LUG ! E COUNTY, f 1r 1 UA ~ -
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t:PU Y LERK Q'
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