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Declaration of Dom~cile and Citizenship
.43`7399
To ~ c~K oF~ c~xcurrcovKr. ;
ST. IIJG I E ~pp~y. ~,pg~A: .
This L m~ declaratioa oi Domldls and Clti:enship in the State ot Florida that I am Slins thi~ da~ in acoordaaos. and in
ooniormit~ with Section ?22.17. F7oTida Statut~es.
I was former a kgal reaident of . I '
n,,~ 1(~t71 . 18tatd
r~sided st nC~ 9 ~ J~" ~ - . Ho~vever. I have ebanged m' domia'le to '
18tiwt aad N~ ~
and am and have been a Dona Sde resident ot tbs State o[ Florida sinoe ~7 ~ - '
19 and I reside at n~ ~ ~
^ ~ (8t~wt ~d I~fumbrl ~
~e ~ 1,~ o ~ ST. lUC I E Count~. F7o:ids,
lCib1 _
and this aLtement is to be taken as my deelaratioa of e3tiun~hip. setwl bgal reaidenoe and domie~le in t6e 3tate at Floeida.
IF FOR THE PURPOSE OF ENROLLiNG If FOR HOMESTEAD PURPOSES~
CHILDREN IN SCHOOL~ PLEASE STATE PLEASE CHECKS ~
THEIR NAMESS
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437~y
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~ I FvRZ'~ CERTIF'Y that I w~l register aL my local addreas when the ngistration books reopen. and oompl~ with all .
! other rcqninments of a legal resident of tLis State. .
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~ I FURZ'HER CERTI~'Y that I have no intentioa to nturn to asy forn~er domicik. and I intend to remain in
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~ Florida. permaneaci; .
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~ ROGER POITRAS. CLERK OF CIRCUIT GOU2T >
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~ ST. LUGIE GOUNTY, fLORtOA ~ ~
~ BY. ' , ' l~
~ . EPUTY LERK ; ~
~ SQG! ~OV -si.~ 440 •
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