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Declaration of Domicile a d p
462521
TO THE CLERIC OF THE CIRCUIT COURT.
ST. LUG 1 E COU~y~ FLORIDA:
Thin is mT declaration of Domia'le and Citiseaship is the State of Fbrida that I am Shag thin da,T in aeoordanoe. and in
oonformit~ with Section 222.17. 1:7orida Statutes.
>~1 ~ ~ l _ and I
I was former a legal resident of
ICk~) 18tatd
resided at Iloweves. I have changed m7 domic~7e to
1 .ed NmsDK)
sad am and have been a bona Sde resident of the State of Florida ainoe ~ Qom,/ 7 9 daT at ~
L -19 and I reside st~~
~ ~ IBC f ~ _ ST . L UC 1 E ConntF. Florida.
and this statement is to betaken as mT declaration of citisenship. utual legal residence and domicDe in the State d Florida.
IF FOR THE PURPOSE OF ENROLLING iF_fOR HOMESTEAD PURPOSES,
CHILDREN iN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
^ e ~ ~
1
ROGER POITR~•5
CLERK ClRC'JIT CC`s~.'
r._~~ .
462521
~ I FtJRT~R CERTT
1!FY that I wal register at mT local address when the registration books rtopen. and eomplT with all
i
other requirements of a legal resident aI this S4te.
I FURTHER CERTIFY that I have no intention to return to m~ former domicile. and I intend to remain in
T. U C I E Couat~.
Florida, permanents; .
? , ~ ,
Q~ ~OUrrr - ~
P-''••Cie Pal ~ ~C'1
~ Sworn to ah~l~before me this ~ ~ dq of !i ~ ~ ~
o~~-~,b a ' . A.D. X9.79 ~ is e e S~ h e~rer
Y
RO ER POITRAS. CLERK OF CIRCUIT COURT
ST. LUG{E COUNTY, FLORIDA
BY: ~
1..,
_ EPUTY t.ERK -
~~~3i8 P~~f~.~71