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Declaration of Domicile and Citizenship
4'~~ 934
TO THE cI.ERtc oFTHE clRCUrr oouRT.
ST. LUC I E OOUN'1'Y. FIARIDA:
This is ~ deelaratioa of Domicde and Gtitizsnahip in the State of Fbrida that I am filing this day in aaoordanas. and in
conformity with Section 222.17. Florida Statutes. ~ ~ d
and I
I was former! a legal resident of
ICit~) IStatR)
resided at ~
~ ,~G"`'~ ~ 9 - However. I have changed ~l? domiefie to
(Street and Nssasbarl
and am and have been a bona fide resident of the State of Fbrida since ~y ~
19
%
/ . and I reside at ,//-3 ti / ~ ~ .
O l8tswt aad Nasaber)
iyj~~ ~ ~ ~ ST. LUG I E County. Florian.
lQb)
and this statement is to be taken as my deelantion of citizenship. actual legal residence and domidk in the State of Florida.
IF fOR THE PURPOSE•Of ENROLLING IF fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK2
THEIR NAMES:
- JAN -9 At; 9~ 12
FILED AMC kECUHOf.O
ST LiiiiE i;uiiriiY.FLA.
ROGER POITRAS
CLERK CIRCUR~ RJ~
4'1984_
I FLJRTIIER CERTIFY that I wdl register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State.
E I FURTI~R CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
I _ U C I E .County.
1CSt7) -
Florida. permanensi; .
s
I
,~~,-ERR--.rte
_
l ?
_j ~
lGC~E yo
COUHr
Q (Adds".)
Sworn to and subscribed before me this / day of
' A.D.19$
ROGER POI TRAS, CLERK OF C IRGUI T COC~ZT
ST. LUGIE COUNTY, FLORIDA
•
BY: Jar
EPUTY LERK ~ •
- 6~32~3 P,~~.354