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Declaration of Domicile and Citizenship
4'71690
TO THE CLERK OF THE CIRCUIT COURT.
_ ST. LUC 1 E COU~Y, Ft.ORIDA;
This le my dee4ration of Domicile and Citiseoship in the State of Florida that I am tiling this day in aooordaaoe. and in
coaforauty with Section 222.17. Fbrida StatutesC..~
I was former a legal resident of ~ • ~ ~ and I
tL~eyi iSt.ci
resided at . However. I have ebaaged my domicile to
. t8ti..t.aa Name~tl I
and am sad have been a bona tide resident ~ the State of Florida since day of
19~. and Ireside at .~v~ .r ~ ~
Ci ~ L~ 33 (Stewt aed Numbr)
~ YJ ST. LUC I E County. Fbrida.
and this statement is to be taken as my decLntion of citizenship. actual legal residence and domic~7e in the State of Florida.
IF FOR THE PURPOSE OF ENROII_ING IF ROR HOMESTEAD PURPOSES,
CHIt.DREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMESS
1980 JAN -1 PN 2~
13sT
f ED I?NO R=CORtIkD
E LUClee COUNTY. Ft A.
OGER POITRAS
q. RK CIRCUIT COUR
RECn1t0 \'aitFt~ 7._
4`71690
I FURTHER CERTIFY that I wi71 register at my beat address when the registration books reopen, and oompiq with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY tlut I have no 'iatentbn to return tom former domicile. and I intend to remain in
U C 1 E .County.
tCig1 .
Florida. permanenci; .
- • '-fit I~ttw Ci~lLi
-'J •
.l •
'
. ~ U Gov, - _ v~
Swifhltwatld subscn-bed before me this day of
RO P01 TRAS CLE OF C IRCUI T COt~2T .{-uca,
T. I E COUNTY, FLOR A
EPUTY LERK ,
aoa~~~ Pact ~3 t