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D~ .~:.:ion of ~~o
4~i'7283 '
TO THE CLERK Ot: THE CIRCUIT COURT.
ST. LUG I E COUNTY. FLORIDA:
This is my declaration of Domict~e and Citizenship in the State of Florida that I am Sting this day in aeeordanoe. and in i
confoFmity with Section 222.17. Florida Statutes.
LOS ~N ! ~'o S c a r , ~0 n; ~ and I
I was former a legal resident of
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resided at ~ ~ C~ ~ . However. I have changed my domicile to
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and am and have been a bona Sde resident of the State of Florida since 'z (O day ~
/ ~ ~
_ 19~. and I reside at ~ ~ ~ ! Ya r ~ ~ ~
18tre~t gad Number)
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~ PSI a ~`C.t° ~ ST. LUG I E County. Flor;da,
(Olty) ~
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State olT Florida. i
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
i
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:'~79 P;Q'i 27 Ati il~ 1:4
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SLLUCIE CONTY.ftA.
ROGER POITRAS
CLERK CIP.CUlT COURT
.44i'7283
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen. snd comply with aU
other requirements of a legal resident of this State.
i
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
' T. U C I E ~ County. i
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0
~ Florida, permanemi; .
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GC~F COUNI~ . F~ (Addrera)
Sworn to a before me this ~
% _ day of
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0 V e M" Q . e.D. i9_ :7/ C I ~A~ ~Jo~ud ~ i / /t M
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ROGER P01 TRAS. CLERK OF C IRGUI T COURT
ST. LUGIE COUNTY, fLORtOA ~ .
•
BY:
EPUTY I.ERK
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