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46'135
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UC I E COU~y, ~,O~pA;
This is my declaration of Domicile and CItizeaship in the State oaf Florida that I am f~7ing this day in accordance. and in
conformity with Section 222.17. Florida Statutes. T rD j~~
I was formerly a legal resident of ~ l-~~ ~ N t ~ 1. t Il. G f~~1 V~_1o and I
IChyl (9tats)
resided at 1 N~ L_~ ~ _ However. I have changed my domic~7e to
Istreet and Numbed
and am and have been a bona fide resident of the State of Fbrida since ~ day at
' -19 and I reside ac :Z 30~ S~. I uC l l` T3 ( U D.
ISteaet and Number) ~
1~
n ~ ~C ~ ~ ST . LUG 1 E County. Florida,
lacy) ~ ;
and this statement is to be Wren as my declaration o[ citizenship. actual legal residence and domicile in the State at Florida.
IF fOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHIt.OREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS i
'079 26 t~.; l: S i
i,
FILED ~hC ^ _ C~~~.Ji u ~
SLLUCIE CCLyTY.FL«.
ROGER POITRAS
CLERK CIRCUIT CrURT/~
PECi?4~ \.Fo~• ,rr 9
4x'7135
I FURTHER CERTIFY that I will 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 domicile. and I intend to remain in
U C I E ~ County.
1 icy _
Florida. permanenci;.
i 5
I ~
ti
~ ~ 1
2so~{ S •i LuC ~E FLU D
V { J ~ J
sworn to an c ore me this ~ day of ~ L Q ~ ~ ~ S ~ '
- _
IV oY-eM e~' _ A.D.19_ ~9
ROGER P01 TRAS, CLERK OF C I RCU 1 T COURT
ST. LUG I E COUNTY, fLOR 1 OA
EPUTY LERK
i
ao~K3~ P~~2729
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