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'AO THE CLERK OF THE CLRCUIT COURT.
ST. L UC I E COUNTY. FLORIDA: •
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This b my declaration of Donucile and Gitisensbip in the State of Florida that I am Sling this d_ sy in aeeordanx. and in
conformity .vith Section 222.17. Florida Ststutes.
I was formerl a legal resident of r C ~ ^,l 1) • - t J • and I
.t 71 IStat~
resided at ~ I ~ l . ~ - Iiotvever. I have changed my domic~e to
(Street and Number) O•_
and am and have been a bona 8de resident of the State of Florida since day d
Q M
19~, and I wide at ~ L 5 ~ CJ X ~Z, ~ ~1~. o^.~_ ~
13ueet and Numbed
b ST. LUG I E _ ~
- _ _ County. Florida.
(~71
and this statement is to be taken as my declaration of otizenship. actual legal residence and domin'le in the State of Florida.
IF .FOR YHE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,; €
CHILDREN. I N SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR>>NAMESS I
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~ P ~ ~~9 AUG 16 PK 2 20
fQEO A~10ppRE~~CORtJEO
$ ROGER
POITRASA•
CLERK CIRCUIT COURT
F.ECCRD ~'ERIFIEO _.r-. , `
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I FURTIiER Cr.RTIFY that I wi11 register at my 1oc81 address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
t
F I FURTAER CERTIFY that I have no intention to return to my former domia'le. and I intend to remain in
T. U C I E County.
ICit~) .
Florida. permaneatl~. ~ ~ f
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OC~F COIYNSV . •
INa.-ne)
E x.95/ ~kmoo~2 ~~.~L
(Addreu)
! .porn to and su)~un~,ed before me this ~ day ~f A l~
~ --9 _
~ ROGER POITRAS, CLERK OF Gfi2CUIT COURT ~ 4-
ST. LUG I E COUNTY, FLOR t UA - ~ . ;4~uE•
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