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D i ' ' ' '
ec[ara~ on of Domicile and C~fii~ensiii~
TO THE CLERK OF THE CTIiCUIT OOURT.
ST. LUC ! E COUNTY. FLORIDA:
Thin is mT declaration d Domidis and Citisenship in the State d Florida that I ann fling this dq in accordance. and is
oonformit~ with Section 222.17. Florida Statutes, 1
I was forme a kgal resident d . ~1 ~E V 1 ll
Q K ~ ~ Tyc I~~ and I .
c~ its)
resided at ~C R C 0 N However, I love changed mr domicile b
It3t:wt sed Nimoib~ .
and am and have beea a bona fide residaat d the State d Florida since ~ dsT d
~e.~R uAR 1!
~a~ and I reside at 3 ~ ~ D W ~A1/ ~d .
C iN _ ST. LUG 1 E - Count,, Florida.
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and this statement is b be taken as m, declaration d dtisenship. actual kgat residence and domia7e in the State d F7a~rida.
Ii fOR THE PURPOSE Of ENRO~L.ING If fOR HOMESTEAD PURPOSES,
CHIt.DREN IN SCHOOL., PLEASE STATE Pt.EASE CHECKS-
THEIR NAMESS
f~~ee.f IC
RTL I F~
f~B 2a Mks t~ z2
F{t.CC ANC F~COf(tk U
gt IUCtE COUtiTY.FIA.
ROGER POiTRAS
CtER1(CtRCU11 C81i T~
itT'CCRO \'_=tFi~F~
I F[TR1'HER CERTIFY that I will register d ~ local address when the registration books reopea. and eo®p~ with aD
other regairemeata d a kgd resident of this State. -
I F'LJRTHER CERTII~R that I have no intention to return to m~ former domicile, and I iatead b remain is
-5T_ -LUCIE ~~T,
r tQt71 . -
Fbrida. permaneatir.
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aa !M~
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_ 3 ~f ! ly;c~C cu~ ~ol
Sworn to and ` _ V before me this g dyr_ot_ W n : T~ / / -
~ i~$o ~ T
ROGER P01 TRAS. CLERK OF C i RCU 1 T COt~2T
ST. LUG 1 E COUNTY, f tOR t OA
. BYz I
EPUTY JERK
. ~ . - - g~326 P~E~.84