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Declaration of Domicile and Citizenship
~62890
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC I E COUIV'rY. FLORIDA: ~ I
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This is my deeLntlon of Domie~e and Citisanabip in the State of Fbrida that I am filing this day in aoeordanoe. and in
conio~rmit; wiW Section 222.17. Florida Statutes.
I was forme 1 a legal resident of ~i'-GL~~-~~~ ~~~'1~'~- - and I
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resided at ~ ~ However. I bave changed my domic7e to
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andam~and have been a bona tde resident of the State of Fbrida since __T lrz~ daj of
.19 and I reside at
ISt,wt sad N 1
~ ST. LUC1E
County. Florida.
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and this statement is to be taken as my decoration of citizenship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OP ENROLLING If FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS r";i"~
THEIR NAMESS j ~-1
;919 OCT 17 1~~: ~ I ~ SO
fIZEO Rk~ ~ccur;ut.~l '
ST•IUCIE CCUNTY.fIA, s
ROGER PQITRAS ;
CLERK CIRCUIT C~JLK
~~GRJ MFR:=irk` _
462890
I FURTIlER CERTIFY flat I wDl register at my local addras wben the registration boob reopen, and comply with aU
other requirements at a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicile, and I intend to remain in ~
U C I E , qty,
l(Sty? i
Florida. permaIIentlj. ~
~GOUNTy '
J •~•.•C~G ,~f ~ .
"X °s - ~ ~ti~•.c~, 335 z
•t?i•~~~J..~. S4'• Cam`
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Sworn to and fore me this ~ day of
ROGER ~ POITRAS,,_ CLERK OF G IRGUI T COURT
ST. LUGIE GOUNTY,~FLORIOA
_ - .
BY: _ ~
_ EPUTY LERK i
~ .