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1.
Declaration of Domicile and Citizenship ~
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TO TIlE CLERK OF TtlE CIRCUIT COUItT. ~
ST. lUC 1 E COUNTY. F'LORIDA:
This U mr det4ration ot Domicilo snd Citiaeaehip ia tha State of ~'lorida that I am filing thb day Ia aceorduKe~ and jn
eontormity with Section 2....'`'.17. Florida 5talules.
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I was tormcrl a kgal rc~ident ot
.-~a~i~c. ~ ~c~y~
nsided ~t ~ = However. I have ehanged my domicik to
(Serat ~ad Numb~rl .
aad am and A~ve been a bona C~de reaident ot the Stale ot Florida since ~ day ot
19~ and I reside at a~'e'
(8tt«t ~nd Nwnber)
` ~,Q Ol~ ST. LUC I E County. Florida.
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aad lhis statement a to bo taken as my declaration oi eitizenship. actual kgal residence and domieik ia the Stste of Florids.
• If FOR THE PURPOSE OF ENROLLING IF i0R HOMEStEAD PURPOSES~
' CHILDREN IN SCHOOI~ PLEASE STATE P~EASE CHECK: ~
THEIR NANES2 _
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~ l FURT~iER CERTIFY that I w~l register at my local address wben the regi~tntion books reopen, aod comply with all
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F other requirements ot s legal resident oi this State.
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s 1 FURTIiER CERTIFY th:t I have no intention to retum to m tormer domicile, and I intend tb remain in j
2 ~ ~ . U C 1 E . County.
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~ Florida. permanenti; .
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Sworn to end subscribed beforc me this day ot ,r-~-~--
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~ • - A.D.19_ `
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ROGER POITRAS, CLERK OF CIRCUIT COU2T ~
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~ ST. LIJG 1 E COUNTY, FLOR t UA
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~ BY:
~ EPUTY LERK
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~ . AGO Furm 71 ~ }
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