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Declaration of Domicile and Citizenship
. ~ - 4'713~i2
TO THE CLEKK OF THE CIRCUIT COURT,
ST. LUC I E w~, ~,Og~A;
This b m,T declaration of Domicile and Citisenship in the 8tsta a[ Florida that I am Hliaa thL day in aoooedanas. and is
coeformity with 3eetion 22Z.1T, Florida Statutes.
I was fob a legal:+esident of ~ ~~~-~-cr.~ and I
(Cltf) (8t~tal
resided at ~ 3 / ~ 1 ~ w-4_ However. I Gave clanged mF domicile to
(BteNt a'd NosbK1 -
and am and Gave been a bona fide resident of the State of Florida since .1 ~ d~ aI
19 7
~
- and I reside at 3 ~ 2-- .
~ `~p~~- lBtrNt aed Nreb~e)
ST. LUG I qty,
tcurl
aad this statement is to beitaken as my declaration of eititsnship, actual iegai residence and domia7e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING ;IF FOR HOMESTEAD PURPOSES
CH 1 L.OREN 1 N SCHOOL, PLEASE STATE r Pt.EASE CHECK:
THEIR NAMES:
a.,
- - ~ JAN -3 A!1 ~ 25
ST~
LUCAN~OUNC Y.~F`A.
ROSER POITRAS
- IXERK CIRCWT
- ~tEC9R0 VERIFIED' ~~~e~"~~"__
- 4`7132 ~
I FT)RTHER CERTIFY that I wH! register at mT local address when the regiatrati~on 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 ~ . Connty. '
(tSt~l _
Florida. peraunenti; - -
. Nt: -
''.~lG ,
Sworn to and
sllbseri6e~ before me this 1
~ 3 day of / 3 ~ Z ~ . .~a~~ ~ a
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f~
_ -
~RA1 c1 ct. A~! _ A.D.19 ,.$.5~_ C A n?oR a rv C~ R Ne .
y~
ROGER P01 TRAS. CLERK OF C IRGUI t COtdRT
ST. lUG I E COUNTY, F>_OR 1 DA
EPUTY LERK ~r c
- BUOK ~ P~Gf ~7