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Declaratia~ o~ t~o~icil~ and Cifi~~nship c~~
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451'792 ;
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~ TO THE CI.ERK OF TNE CIRCUIT COURT. ,
ST. LUG 1 E cpvt~ry. r~,pRIDA: .
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This is m~ decluatioa of Domtca7e and Cititenshlp in the State oi Florida that I am filing this da~ in aoeordanoe. and Is
eonforraitj ~?ith Seetion 222.1T, Florida Statutes. i
l o ~ ti ~ ~ _ ~J~ ~.v -~'r s ~ ~
I wu former a leg~al resident of ~Z ?~~d I ~
lAt~l
n~d~ ~ ~ Q S .t-t ~ U ~ - Ho~vever. I have e}sanged ~ domic~e to }
t ~ad Numbarl - '
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and am and bsye been a boaa fide resident of tho 3tate of Florida since ~ l dy ai
V l 19_.T./- and I reside at ~ S S~ ~1~~' ~ lfO /Z - -
(8t,ret aod Nnmb.r)
f~p rZ i ~ T. ~ v c ~ r- _ ST . L UG I E Count~, lF7orida.
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and this statement is to be taken as m~ declaration oi eitizsnship. actusl legal residence aod domics~e in the SLate oi Florida.
Ii fOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES~
CHIIOREN IN SCHOOL~ PLEA_SE STATE PLEASE CHECK:
THEIR NAMESt
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~!9?'9 I 7 A?; 11= 32 '
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Fi~to ~tie r:_caRU~o E
ST.lUC1E COUHTY.ftA.
ROGER POITRAS
CLERK CiRCt11T CQI~~-- ;
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451'792
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I FURTHER CERTIFY that I w~71 register at my local addresa ~vhen the registrateon books reopen. and eompl~ with a11
~ other requiremeats of a legal resident of tlti.s State. " .
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I}'UgT1~A CERTIFY tbat I have no intentioa to return to m~ lormer
d_omie~e.. and I intend to remain in
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J l. V~. 1 L - CiO11DL~•
E ~c~>> .
~ F7orida. Permnnend~. ` ,
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S.vorn to and subscn'bed befon me this da~ of U~~~/~' - ;
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_ . A.D. I9_ . ~
5 ~79 .
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ROGER PO 1 TRAS, CLERK OF C I RGU I T COt~tT , , ;
ST. LUGIE GOUNTY, FLORiUA -
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BY: - ~
_ EPUTY LERK ~ • ~
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• B~1r)K3~2 ~b`E2439 - ~
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