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Declaration of Domicile and Cit~zensh~p
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To THE cI~ERK of THE clRCUrr covRT.46,29Q4
ST . L UC I E courrr,r. FLORIDA:
This is my declaration of Domicile sad Citizenship in the State of Florida that I am fling this d~ in accordance. and in -
oonformit~ with Section 222.17. Florida Statutes.
I was formerly a legal resident of ~ ~ % ~ C F r~ 1q and I •
_ ICit~l IStata)
resided at jl a 5 ~ ~ 1 S S / - However. I have changed my domicile to
i~ sad NomDar)
and am and have been a bona Sde resident of the Sw,e of F'brida since ~ ~ b day at
.19~_Q.. and I reside at s ~ ' ~ ~ 'g-~
18traat sad Nnmbar)
ST . L UC I E County, Florida.
IQtyl
and this statement is to be taken as m7 declaration of citizenship. actual legal residence and domicile in the State of Fbrida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOLz PLEASE STATE PLEASE CHECKS
THEIR NAMES:
;919 OCT I7 P>; I~ 86
FILEO A~:: F~CG~Ct U
S
ROGER POITRAB~,
ttERK CtRCtttT Cp1tR1
R~CQRO Yf FlFtF^--_ _ _ _ _ - - -
E I F'[JR1'fIER CERTIFY that I wdl register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domic~7e. and I intend to remain in
F U C i E _ County.
s IC5g1
t Florida. permanents; .
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y,, , c,. c caL r t- CR, 1n e
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~,t;.l,~ sto ~ ~~t~bed~efore me this ~ say of
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y--~.- A.D.19_
ROGER -POITRAS. CLERK OF CIRCUIT COURT
COUNTY f LOR 1 OA
ST. LUGIE , •
• - , s ~ - l
BY: - - _
` - EPUTY LERK ~ ~
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annrr . D~GL ~ - -