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Decl~?~..:'.~ _ ~~r~~iL~ t~ ~i~~ize~sf~i
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4~'~399
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UC I E CO~gy, ~,O~A;
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance. and in `
conformity with Section 222.17. Florida Statutes.
I was formerly a Legal resident of F_~T P I hPG F" ~ L . and I
1(tity) ~ lState)
resided st /OHO G dt°O yi9 1- /~A L 'Gt/i4 Y . However. I have changed my domicile to
IStreet and NamDar)
and am and have been a bona 5de resident of the State of Florida since TIY~' i / day of
/yO y E l3 ~ jP ,19 ~q
- and I reside at ~q BAy S/fO yP~' a?. A~°r' - 3t~ a3~
13tr~at and Nnmbed
E dPC E ST. LUG I E County. Florida,
1(xt7)
and this statement is to be taken as my declaration of citizenship. actual legal re.~idence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PI EASE CHECK:
THEIR NAMES:
t
'~'9 ~?Y 28 III
. f iii..:: F.7?L ril:u•.rt f+ ~ ,
ST.IU~if CG:::~Tl'.FC...
ftQGER POITRAS
ELE~2iS CII'Ct'!T r:.UR i
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4~i7399 }
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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 intxation to return tom former domicile. and I intend to remain in
, U C I E , aunty,
j 1(~ty)-
E Florida. permanenti, .
g~ i3
4,
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7D
~~cyf'O•'+rc ~~v~`..:~`p~ - (Mama)
rdUN1V.f~~ 13aj 3RY SHof?E ~B?.
(Addraa)
i Sworn to and subscnbed before me this ~ day of 1~T• F,GPC E' ~ f
L . 3 3 ~ S~
~ _
r 9
_ , A.D.19_ ~ /
RQGER PO I TRAS. CLERK OF C IRCU 1 T COURT
ST. LUCIE COUNTY, FLORIDA
BY :
I EPUTY LERK
s BOOK 321 Pa~E ~