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. 465"718 ~ ~ ~
'FO THE CLERK OF THE CIRCUIT COURT.
ST. LUC 1 E COUNTY. FLORIDA:
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~ This iu my declaration of Domic~e sad Gltirtnship in the State of Florida that I am Sling this day in seaardanoe. and in
conformity with Section 222.1?. Florida Statutes. 1 J
I was former a ]egal resident of 1/ ana I
lOty) IStai~
resided at Ao~vever. I have changed my domiule to
IStreet and Numbet)
and am and have been a bona Sde resident of the SLte of Florida since ~ / day of
.19 and I reside at
_ - (Street sad Number)
~ ST , l UG 1 E County. Florida. _
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and this statement is to be taken as my dedaratioa of atizenship, actual ]ego] residence and domia7e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOLr SE TATE PLEASE CHECK:
THE R NAMES:
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S RoGE~
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c~fax ui:~-c:t tQC 1
4~i5'718
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~ I FURTHER CERTIFY that I wt11 register at my local address When the registration books reopen, and comply with all
j other requirements of a legal resident of this State.
t I FURTHER CERTIFY that I have no intention to return to my former domic~e. and I intend to remain in `
E J T. L u
c. County.
Florida. permanentI;. '
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S•vora to and m' before me this /3 day of
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e r-e M ~ e ~ ~ , /~D.19
~ ~ - ~ Mies ~ I'.af~ ~'t: t 4, ' ~0 4 N JO N
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ROGER POITRAS. CLERK OF G IRGUI T COURT _ . ~ . _ .
ST. LUG I E COUNTY, 1` LOR 10A .
BY• ~ ~
• _ EPUTY LERK _
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