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Deciarat~on of~ Domicile and Citizenship
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TO THE cL>:Ric oFTHE clRCUrrcovlrr. X314825
ST. LUC 1 E COUNTY. FLORIDA:
This is my declaration of bondcile and Citizenship in the State at Florida that I am tilinE this day is aowrdanoe. and is
eonfosmity wKh Section 228.171lorida 8tatutee. ~
O~ie andl
I was for er a legal resident d ~¢y~ .
resided at ~l~ ~ - ipUl (etaW
O s~'F ST _ However I bv. cbantsa m~ aomid{e to
tatr..t.aaNas~b~el
snd am snd have been a bona tide resident of the State a[ Florida since dU' ~
~,~t,l~" . liil.~and I resident 3a -s~A! ~ /`t.t. ; T ~ .
P~' .Sr' ~ k ~ (8te~aRaadl~losfbstl
ST. IUCIE
iClyl
and this statement is to be taken as my declaration of dtisenship. actual legal residence and domidle in the State at F7oeids.
IF i0R THE PURPOSE Of ENROLLING IF fOR HOMESTEAD PURPOSES,
CHlli)REN IN SCHOOLS PLEASE STATE PLEASE CHECK:
THEIR NAMES:
-
FILED AND` RECORD~Eb+_ -
cT, I.L+Cf~ t".GUi1TY: FLA.• -
~,~J -
'T9 FE6 21 PM ~ : 32
. ,t ~.v`..,, t
CLERK ~1RCC~T COISRT
I FURTHER CERTIFY that I ~ register at my local adde+ess when the registration books reopen. and sompllr with all
other requirements ai a legal resident of this S4te.
i
_ I FURTHER CERTIFY that I have no intention to return t_o m~ former domie~e, and I intend to_ remain in
U C 1 E .County.
~ ~acy~
Florida. permanend; .
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sworn to and subacribea betore me this ~L_ day of ysd~-
~f 9
ROGER POITRAS. CLERK OF CIRCUIT COURT
a
ST. LUC COUNTY, FLORIDA
gY:
PUTY LERK
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