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Declaration of Domicile and Citizenship ~
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TO THE CLERK OF THE Clli(.'lJ1T OOURT. ~
ST. LtJG 1 E apv~, ~,p~m~: .
7bts i~ m~ dselantton ot Domk~ a~d C~tiuns6ip in ths 8lst. o~ Florida tbat I am Slie~ tbis d~ in aooordaoa. aud js -
ooafa~mit~ witb 8~etioo 222.1T. Flo~ida Statutes.
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I was f~ a 1ega1 rasideat o[
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nsided at • Aow~ver. I have e6anaed m,~ domia'!s to
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and sm wd bave beeA a bona fde res~dent d the SW,e oi ~ sinoe / ~
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(8t~.~t na IirsD.rl ,
ST. ~11G I E F~.~ ~
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and tlus statement is to be taken as aq deeLration a~ dtisenship. actual legal residenoe and domin7e in tbs 8tats d t7otida.
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IP POR THE PURPOSE Of ENROLLIN6 Ii FOR HOMESTEAD PURPOSES~.;
CHILDREN IN SCHOOL~ PIEASE STATE PLEASE CHECK: .
THEIR NAMESS ~
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ST.LUCIE CCt1,VTY.ftA.
ROGER POITRAS ~
. CIERK CIRCUIT CO~~
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i I FZTR1~i CERTII~'Y that I w11 register at my loe,al address wben the registration boob r~eopen. aad oompl~ wit6 all
i otber nqninmeats d a kgal resident a~ tbis State.
~ I F'IJATHEA CEIt1'IFY that I iuve no intentioA to retarn to m_ former domie~e. and I intend to nmain in
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~ Florida~ permanend;. ~C~Z-~~L--~ '
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~ Swan Lo and snbser~'bed before me this ~ da~ of ~l/'' 'Z-~ 1~_e~ !
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; C~~.~.-~ A.D.19_, ~ / -
~ ROGER P011RAS. CLERK OF C IRCUI T GOU2T .
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ST. ~UGIE COUNTY, FtOR10A ~
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BY:
_ EPUTY LERK ir ~ .
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pGO Fn-m 71 22
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