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• 46388 ~ ~
'f4 THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY. FLORIDA:
9liis is my decluatioa of Domicile and Citizenship iv the State of Florida that I am 51ing this day in aooordanx. and is
conformity with Section 222.17. Florida Stat/utes.
' I was formed a legal resident of Q~+ f?~~/a~d - ~ ~ I
jG5y1 tStaW .
resided at l ~ G~Peerl r~ yGE L P, i S, W . _ However. I have changed my domic~7e to
(Street and Numbv) ~
and am and have been a bona Sde resident of the State of Florida sinct ~ 4 T-1 dal ~
O? ~MbV°~ _19 7~ -andIresideat ~oO2 ~RIheVILlt
IStrsataadNombesl
Po•~2 T S 1
r"• L- CJC f L= _ ST , L UG I E County. Florida,
lCit7)
and this statement is to be taken as my declaration of atizenship. actual legal residence and domin'le in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL,PLEASE STATE. PLEASE CHECK:
THEIR NAMES:
~R~s~ Rae ~3u~nus
' I~79 ~'Jtr ~ 9 P:'i Q8
F-IlEO akC F.tftid~t U
ST. Li~IE CQI,W I Y. Ft A.
ROGER POITR.".S
CLERK C:P.~UlT CJ r^.T
REC£zOYEr i''~_
466388
I FURTHER C>:'RTIFY that I w~ register at my 1oca1 address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
i€
I FURTHER CERTIFY that I have ao intention to return to my former domic~e. and I intend to remain in
I
• T U C I E County.
_ ICiq)
Florida. permanenu~
_
I
_
c t'r c
~~-r~~l p (oa ~R~NeYi~~~
(1
sj~,,,~~.~::~~~°~ - _ V
oar S7. L~~~P 33 yea
Sworn to and snbsttt'~ed before me this day of .
.79
ROGER POITRAS. GIERK OF CIRCUIT COURT . .
_ .
ST. LUGIE COUNTY, FLORIDA _ - ~
BY: ( .r
• EPUTY JERK