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Deciaration of Domiciie and Citizenship
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TO THE CLERK OF THE CIItCU1T COURT.
ST. lUC I E aovtv~rr. F1,ORIDA: ~
Tbb is my deelaratbn o[ Domleils aad Citiunahip In Lhe Stats oi Floeida that I am t~ins this dp in ~ecofdsnee. and in
contormity rvi/h Scctioa 222.1T. Florida Statutei.
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I wu tormerl a kgal nsideat ot /N f r j~,~ L~~ - -
ICltf) ' ` - - -~~tatd =
resided ~t 7. ~1~ ~ CAIeC.~b~ 1~w!! DR
~ - However. I havs chang~ed m~r domicik to
t8t~t a~d Nambel •
u~d am aad have becn a sona Gde restdeat ot the State of Florida s{ncs .Sd Tf~ ~,y ~
/+~t /4'R;G tF ,1~~ ~ad I reside a~ ~g•26 C • L~ ~ G~2 ~l~ DO N ~
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(BteNt ~ed Nwoberl
Pn Q T ~ST • L~J« L ST. LUC I E Ca~tr.
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and this statemeat is to be takea as my dedantioa oi eitisenship. ~etu~l kgal reaideaoe and domkile in the State ot Fbrida.
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IF,iOR THE PURPOSE OF ENROI.LING IF fOR HOMESTEAO PURPOSES~
' CHILOREN IN SCHOOL~ PtEASE STATE PLEASE CHECK~ ~
THEIR NAMES: -
. - '~I9 J~J~~ 25 A~! !I~ ~~6
f N.ED AdG REC4KOf 0
s'CIUC~ LOtAtTY. f LA.
ROGER POITRAS
CLfRK ClP.CU1T C~
F.FCO?t1 V~~'~~':~--~=
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' I FUATHER CERTIFY that I w~71 register at my local address w+hen the registntion books reopen, aad comply writh all
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~ ot6er reqwrementa ot a kgal resident ot this State.
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E I FURTHER CERTIFY that I have no int~ntion to return to m former domicile. and I intend to remain in
~ U C 1 E County.
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Fbrida. permanenti; .
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~ Sworn to and subscribed before me tfuw day oi ~ 6 R T S~ J
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A.D.19_ 79
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~ AS C ERK OF C IRCUI T COl~2T ' ~
~ ~ ST. LIJG 1 E COUNTY, FLOR 1 A 3
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€ EPUTY LERK
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