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D~~i~ration of Domicile and Citixen~hip
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TO THE CLERK OF THE CIRCUIT COURT.
ST. L UC I E CpvNi~r, FLORID
This b aql? declaration of DomieDe stud Cltisenship in the State of Fbrida that I am iiHn,~ this dai in aoeordance, aad iD
F :c°nt°r"'itF witA Section 222.1T. >;7orida Statutes.
I was fob a legal resident of €'fif ~ -TS L ~ ~ /y, G
f and I
resided,at - However.Ihave
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an-d am and have been a bona Gde resident of the 8tats of Florida since ~ ~ `fit • dy ~
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d___~ and I reside at ~3~4 ~~A ~
_~d,t0 T ~T~ •~dG/~ ST. LUG I Esa~.e.paNooe«t
and this statement is to be tatea as mp declaration of citiaenahip. actual legal residence and domia'le iA the State of Florida.
IF FOR THE PURPOSE Oi ENROLLING IF FOR HOMESTEAD PURP05E ,
CHILDREN IN SCHOOL, PLEASE STAVE PLEASE CHECK:
TNEIR NAMES:
r
~~f'/6~,d Q ` ~E~,c~~' 1980 ~E8 -8 ~ i!= 21
M f0 A POITRA A•
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I FURTHER CERTIFY that I w~7) register at np local address when the registration boats reopen. and oomplF .ritb all
other regniremenb of a legal resident at this State. -
I FvRTHER CERTIFY" that I have no intention to return to - forager and I intend to remain is
. 4J E . Cornty,
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Florida, permanend;.
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Sworn toaad sabsmbed beton me this g dad of ~ _ /~~r . S`Jr.
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RgGER POtTRAS, GLERK OF .G1RCUi f COtdFtT ~bRofd~/ 0~ ~~i/~
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ST. LUCIE COUNTY, f~ORtUA
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iSEPUTY tL
ARK-""'
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