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TO THE CLERK OF THE CIIiCUTT CAURT.
ST. LUG 1 E oovl~rlr. FLORIDA: - .
This is'boy declaration of Domiele and Citisenship in tba State at Florida that I am Sling this dq ;a accordance. and is - ~
eonformitj with Section 222.17. F9orida Statutes.}?J / , ,~w .
l / 1 I'l~~t 'C~ ~L G t° ~ /-f and I
I was forn~erl a kgal resident d ~
1CK71 l8tstd
resided at ~ ~ G ~ ~ ~ -However. I have e>sauged m, domia7e to
tstrst.aaYimae.rl
and am and have been a bona fide resident of the State of Flo ' g ~ ~ 7 ~ ~ ~
- - ~ -19 ~ - and I reside at ~ ~ ~ 1 ~ ~ ~ ' ~it ~LOrr ! li G l~ ~ Y'
/ tBtredesdNombsl
- C yt J ~ h ~ ~c-h _ ST. LUG i E County. Florida.
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and this statement is to be taken as my declaration of citizenship. sctual legal residence and. domiesle in tbs State d F7arids. -
If fOR THE PURPOSE Of ENROLLING - IF fOR HOMESTEAD PURPOSES,
CHILDREN IH SCHOOIr PI.EASt STATE PLEASE CHECKS
THEIR MANES: _ '
- ~9r9 C`"? 25 Ph OS -
- f ILEU Ahf hE 'unUE u
ST.IUCiE COUNTY. f t A.
ROGER POITRAS .
CLERK CIRCUIT C01
- F~CC~D VER~Fiffi
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I FIJRTIiFR CEBTIT'Y that I w~7I register at my loal address when the registration boe}s ;open. and comply with aD ~
other regmrements et a kgal resident of this State. -
I F[JRTAER CEBTIF'Y that I have no intention to retarn to my f r domic9e. and I intend to remain in -
T. U C t E _ County.
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E
Florida, permanenil~
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T.1- (AdBew)
Swore to and snbsen'bed before me this a.~ daj of ~G f?/' C ti ~ CRS ~ 9
_ _ ~ Jr, -
A.D.19~~/ ~ - ~ `
_ •
ROGER POITRAS. CLERK OF CIRCUIT GOURT
ST LUGIE GOUN7Y, FLORIDA - _
BY: _ -
EPUTY ERK ~
X317 P~ 7~9 ._.Y - -