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'FO THE CLERK OF TIC CDtCUIT COURT. .
S'~.. LUG 1 E ppt~q. ~,O~A; `
~ `,'1'hia is my deeLration o[ Domie~e and tSlt>aeaship is the State aI Florida thst I am 51ias this day in accordance. aad i>,
conformity with Section 222.17. )7orida Statute:.
' I was fob a kgal resident of ~ _ C_. ~ ~ ~ ~ and I
ICttyl lStaW t
resided at ~ ~ ,5 ~ y Y Cd CL . ~ ` _ - However, I have changed my domieDe to ~
IStreet asa Ntabarl
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and am and have been a bona Sde resident of the State of Florida since C.~=,~ ~ y
~ ~ .19~.~. and I reside at
T l ~ ~ 1^~ ~ _ r ST. lUG ! E ~ county. Florida.
tcny,
and this statement is to be taken as my declaration of dtisenship, actual legal residcnae and domics~e in the State of Florida.
IF FOR THE PURPOSE Oi ENROt.t.t'NG IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL., - PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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F - 199 DEC 27 A!~ :D~ 24
IlEO ANNCc RECOAUEO
C` LUC,I~000NTY.FLA.
ROGEtfn~ POITRASS -
ERK CIRCUIT COU T
- I~CfIRl1 YCRIFIfO~~ .
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I I FURTHER CERT7p"X that I w~ register at my local address when the registration books reopen, and comply with aD
other requirements c[ a legal resident ad this State.
I
I FURTHER CEIt1'g'Y that I have no intention to return to m_v former domicile. and I intend to remain in
T. U C I E ,County,
- l(~ty)
~ Florida. permanend;.
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Swop to and snbsen~bed before mr this _ e~ / _ day of ~ ~ ~ ~ ^ c' - - t
~ceaibep ~ .1~D.19;`r9 ~ C R~b.~ L- ~ooxele
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ROGER PO I TRAS. CLERK OF C 1 RCU 1 T COURT ` , y .
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ST. LUG 1 E COUNTY, fLOR 1 OA -
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- EPUTY LERK _ II~~77