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Deciara~~an of Domic~le and C~tizensh~p
448855 ~
TO THE CLERK OFTHE CIRCUIT COURT.
ST. Ll1C I E CoUNrY. FI.ORIDA: ,
1'his is my declaration of Domic~e and Citizeaship in the State oi Florida that I am filing this day in accordaace. and in
eonformitp w ith Section 222.17. Florida SLatuLes.
I K as formerlv a lega) resident of f~Or"~'~. 1~o~~w~ r.KO~,c~ F~~.-~~d and I
ICit~) (Stat~
resided at '1 ~yy Tin~,c~ew~~u~ u~ , However.l have changed my domic7e to
lStteet and Number)
and am and have been a bona fide rnsident of the Stste of F7orida ~ince l~+~ day oi
_ _ i~~ and I reside at ~i~~ ~~~^~+or•i ~~`-e- • .
(Street aad Number)
c~~ ` ~ ST. Ll1G I E Count~, F7orids,
1~1t~)
and this statement is to be takea as my dedaration of cituenship. actual 1ega1 residence and domia~e in the State oi Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAO PURPOSES~
CHtLOREN IN SCHOOL~ PI.EASE STATE PLEASE CHECK: ~
THEIR NAMES:
.-1c'~l~ N ~ t c. C.a( ~ aa q q C~ _
~;,~~N n~c~.~a Q~e
l919 Jll~ 22 A'~ 3~ ~ 4
FILEO AK~~ kk.1.OM.~EO
ST lUC1E COUNTY.FIA. -
aoGER POITRaS
ttERK CIRCUIT Ca~1~ n'
r
RECQfO ~'EF1~'fC Hj-:•:~~
.448855
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~ I FURTHER CERTIFY that 1, will register at my local addre~s when the registration books reopen, and comply with all
~
~ other requirements o! a legal resident of this State.
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j I FURTHER CERTIFY that I have no intrntion to return to my former domicile, and I intend to remain in
T. U C I E , Count~,
t .
~ ICit~) _
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~ Floridi, permanenti, :
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~ Sworn to snd subscnbed betore me this ~ da~ oi U~ P rL~- ~j ~~~D
~
~ - - . .
~ A.D.19
~ ~9 •
~ ROGER P01 AS, CLERK OF G IRCUI T GOl~2T
~ . . -
~ ST. LUGI E GOUNTY, FLOR - •
~ ~ '
~ BY: .
.a
EPUTY LERK ~ '
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