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Declaration of Domicile and Citizenshi
P
~~2899
TO THE CLERIC OF Tl~ CIItCUIT COURT.
i
ST. LUC 1 E COU~y~ FLORIDA: I
i
This b my declaration of Domia7s and Citizenship in the State of F'brida that I am Sling this day is sooocdanoe, and in
conformity with Section 222.17. Florida Statutes..
I was former a legal resident of W A r t~
o Q D ~ o N Nc c T. c v T ~ I.
tC~t71 (9taW
resided at ~Co CL . Fro s T,e ~ c r' However. I have changed s41 domie~7e to
(BteNt and I~Iamb.el -
aad amand have been a bons Sde resident of the State of Florida ainoe ~ a'y day o[
-19 - and I reside at - G y9 S W G~ y r~ r ? s T.
(8treet sad Ham!
PQ ~ r sr. .C yc , ~ ST. LUG I E Counti. ~7arids.
cc~,~
and this statement i, to bs taken as my declaration of citizenship. octant legal residence and domicale in the State of Florida. .
• IF FOR THE PURPOSE OP ENROLLING - IF FOR HONESTEAO PURP05E5~
CHILDREN IN SCHOOI~ PLEASE STATE PLEASE CHECK: ~j-{
THE 1 R NAMES: ~ ~ 1
- X80 JAN 17 AN ~ ~ 3
- .3
fILEO AND PECTORDED '
` $T~QGER
PO
TRAS A-
_ ~ CLERK CIRCWT LOUR -
_ ~ RECORD ~'EFIFIEC___ ~ .
_ - 472899 '
I FURTHER CERTIF3C that I wt71 register at my local address when the registration books reopen. and comply with all
other requirements of s legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicIIe. and I intend to remain is
c ~ _ U G I E County.
(Cyty) .
Florida. permaaend;•.
1
5~,~~ f f~`~'
(AddreM)
Sworn to end subsrn'bed before me this ~ ~ day of _ ~ v T .1rT •C (~C ~ ~ ~
'
A.D.19 V
ROGER POITRAS, CLERK OF GIRCUI ~ COr~FtT
ST. LUGIE COUNTY, FLORIDA
BY: • -
EPUTY LERK '
. BOON ~PI~ PaGf LA~JV