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465356
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC i E CO~q~ ~,p~~
4'his is my declaration of Domics~e and Citizenship in the State of Florida that I am filing this day in :ocordanoe. and in
conformity with Section ?22.17. Florida Statutts.
- • I was formerly a legal resident of ~/N~ ~~Z~ ~ ~ ~d j
S ~t~) . 1Sw•)
resided at ~ However. I have changed my domic~e !o
(Str:et sad N~besl Q
and am and have been a bona Sde resident of the Stan of Florida since,
- - day of
J _ 19 and I residt at ~ y~y//l~l~~~-/5f'~I~LJ
t 13trbec aadNnmber)
DIP7r ~V~ > E ST . L UG I E County, Florida,
Ilan)
and this statement is to be taken as my declaration of dtizenship. actual )egal residence and domia'le in the State of Florida.
Ii FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,;
CHILDREN IN SCHOOL,•PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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~ ,C/j//(/~ ~Eje ~V/1 CLERK C:t:'_'t~i i .,G:l~j~
J _ _ .
46.5356
I FURTIiFR CERTIFY that I w~71 rrgister at my )oca] address vehen the registration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHER TTFY that T have no intention to return to m_v former domiu'1e, and I inl.end to remain in
_ T. U C I E _ County.
_ l _
Florida, permanenti~. _
J
.
.
. _
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Sworn to and anbsm"bed before me this O day of ~
ROGER POITRAS. CLERK OF CIRCUIT COl~2T .
ST. LUG 1 E COUNTY, FLOR 1 OA -
. /
BY.~ ~ -
" EPUTY LERK
- - G~~x 3~9 PacE~;~~_