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4'7Q695
'FO T~ (~.ERft OF T~ CIRCUIT COURT. .
S'i;. LUC 1 E ppj~y~ ~,O~A;
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~ ` This is ~ dedaration o[ Damic~7e and (xtiseaship is the State os Florida that I am flint this daj iu accordance. iad is
_ eonlormitT with Seetiaa 22Z.1T. >!7orida S4tntes.
I was fob a legal resident olT ~ 1 M S .8 V R~1 _ G ~ - I '
tCit~l . ts~aw
resided at 5 ~ C~RV ~ ~ t' G t-~- - flowerer. I have changed m~ domia'1e b
IStyset grad Nmsbet) ,
and am and have been a bona fide resident of the State of Florida since ~ Z ~
~ daT of
t•t 1 ~i F}
~ ~ ~ M [~1= i~ = is r and I resde at , ~-~4 k ~ ~ N~ h? 1~! t~ t D t t~'r •
tsa..~,saxs~
FD ~1 ~11c- GC ~ ST. lUC i E Connt7.Floaida.
tats)
and this statement is to be taken as m~ declaration of dtiunship, actual legal residence and domicile in the State of Florida. ,
IF FOR THE PURPOSE OF ENROLLtNG IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL,-PLEASE STATE PLEASE CHECK:
THEIR NAMES:
s
l9T9 OTC 27 il= 13
.ftI~L~~EO ANC RECOIiDEO
S~tOGER
POITRASA~
~tsalc claculT j
4'7t~695
I FURTHER CF~iTI>:'Y that I w~ register at mT lonl address when the registration books reopen. and oomplT with aD
other regnirementa at a Legal resident oI this State.
I FURTHER CER1'g'Y that I have no intention to return to m. former domicile. and I intend to remain in
. T~ U G I E _ Count.
_ tt~t~)
Florida. permanenti~.
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- i
_ 1 ~ ~ ~ ~ AK
~ ~ ~ F~J P ~ 1~ . ~ 0 I Tyr
(Addy...)
S..orw to and snb~Sbed before me this daT of , S C C ~ q , ~
_ _
1~eceMbeP' .a.n.19; ~ (1N~l~UR ~e ssleR~
ROGER POITRAS. CLERK OF CIRCUIT COl~2T ~
• .
.
ST. LUGIE COUNTY, FLORIDA
BY:
EPUTY LERK 1~`2~`~ _..,~c~?7n