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>;O THE CLERK OF THE CIRCUIT COURT.
ST. L UC 1 E coUrrrlt. FI,oRmw:
This is my declaration of Domicsle and Citizenship in the State of Florida that I am fling this day in a~rdant~e. and is
conformity with Section 2?2.1T. Florida Statutes. -
R ~ C~ F-1 r O tit r C ~IC~ and I
' I wu formed a legal resident of
lGlt~) . IState)
resided at ~ ~ y ~ L I ~ - However. I have thapged my domicile to
(Strret sad Number) '
and am and have beta a bona Sde resident of the Stitt of Florida since ~ ~ ~ ~ ~ ~ K'_ " I day of
19!
~ - and I reside at ~ ~ J
13treec ¦ad Number)
f.- ~ [ j / ~ , ST . L UG I E County, Florida,
((St7)
• a • e~_ .-r .r-. .:1. •1.. Ct,ti. of Flnridi
and 11115 SLattmenL r5 LO OE I.aACD as my UCGarauUD Ul UusCL~lur, sasusr .cga~ ¦c5•ucuic o..v _ _
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL,•PLEASE STATE PLEASE CHECK:
THEIR NAMES: •
- ;ohs ~~O~i -8 39
i1LE0 ~h' ~~CUrtuEO
SLLtlC~E CGJYIY.FLA_.
- ROGER PO~TRAS
• CtEP.K Cir2C~Jli Ct:UEti
45300
i
I FURTHER CERT'IF'Y that I wz71 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 to m. former domic~e. and I intend to remain in
T. U C I E ~ County.
- bZ.~ ~ ~
Florida. permanenti;.
.i~..~;r~.:.
~ '~i ~
~ ~ ~ i
e
.'7. ~'e. .•'ti~ IAdd~..a)
Sworn to aa~ . ~ fare me this cLy of ~
r
RQGER POITRAS, CLERK OF CIRCUIT COURT _
,
ST. LUG1E COUNTY, fLOR10A -
BY: -
• EPUTY LERK ~ -
- i