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Declaration of Domicile and C~tiienship y~ ~
451068
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TO THE CI.ERK OF THE CIIiCU1T OOUAT. ~
ST. LUC 1 E ~pv~y. ~,p~w: . ~
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17~is b m~ deeLration d Domietle snd Cttt:enship ia tbe Stat~ ot F7orida tl~at I am ~ing this d~ in ae~or~daaa. and ia
eonformit~ ~rltb Seetion 222.17. Piorida Ststutes.
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I was forme a legal nt ot ~ - ~ and I `
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resided at - -t~ However. I i e6aa~sd ~ domie~is to
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aad bsve been a bona Sde resident ot tDe $tate d Florida sinoe -Z dq at
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n _ , i~ ~a ~ ~ae,?t `~~~-yl-c-~z-~~ ~ c-'
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~ ' ST. LUG I E
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aad this statement is to be taken as m~ decLntion c~ eiti:enship. aetual kgal reiidenee a~ domie~7e in tba State d Florids.
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IF POR THE PURPOSE OF ENROLLING • IP FOR HOMESTEAD PURPOSES~ ~
CHILDREN IN SCHOOL~ PLEASE STATE PLEASE CHECK: ~
THEIR NAMES2
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19T9 JUI. I I P~~ ~ 27 ~
F{LEO Akt~ h.~C~nucU ~
ST.IUC~E COUHTY.FLA. ~
ROGER POITRAS
CtERK CIRCUIT COtl - Q.,~ =
F.ECORD vc:.s::_t~_~. _ .4+~1= ~
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451068 ~
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~ I FURTHER CERTIFY t6at I wn11 ngister at my loeal addnss ~vhea the ngistntion books reopen. and oompl~ with all ~
; other nquirements oi a kga! reaident a~ this Statr.. ~
I F~JRTHER CER1'IFR tbat I have no intention to retnrn to m former domicik. and I intend to remain in ~
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~ Fbrida. Permanend; .
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' Sworn to and snbsetibed belore IDe this ~ da of ''~~~'1 ~I ,`.,C t_ c_ ~`''y~~
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~ ROGER P01 TRAS~ CLERK OF C I RCU 1 T COUZT
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~ ST. LUGIE COUNTY, fLORtOA - ~
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BY: ~
EPUTY LERK " . ~
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