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Declaration of Domicile, and Citizenship
4[1502
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E CpUr1Ty, F-L,pRIDA;
This is mT declaration of DomicDe and Citizenship in the State of Florida that I am Sting this da,T in accordance. and in
conformity with Section ?22.17. Florida Statutes.
I was former a legat resident of 5 V~ , ~ ~ ~ ~ ~ L- I FO ~ N I ~ and I
p l(~71 IStata)
resided at a y ~ g 1 GLOVE _ However. I 1?ave changed mT domic9e to
(Strut snd Nambt) T
and am and have been a bona fide resident of the State of Florida since ~ ~ dy of
ma~c~
.19 ~ t - and I reside at ~ ~ ~ 5• ~ ~ ~ R (DG ~ Po,e ~
Pd RT S% L..t~C ! Iv ST. LUG i E~~N'~)
Count. Florida.
IIRb)
and this statement is to be taken as mT declaration of citizenship. actual legal residence and domic0e in the State ai Florida.
'IF FOR THE PURPOSE OP ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, Pt.EASE STATE PLEASE CHECK:
THEIR NAkES:
l9R0 t41tR 24 n~: 3' 48
faEO•no gFCU~:?EU
ST.LUCiE COUN1Y.FtA.
ROGER POITRAS
• ~LEBII CIRCUIT C T
RFt@Aa Y£RlFf:Qy_
.
I FURTHER CERTIFX that I wt71 register at mT local address when the registration books reopen. and complT with all
other regtirements of a legal resident of this State.
I FURTHER CERTIFY that I leave no intention to return to mT former domiet7e. and I intend to remain is
JT. LUGIE
.Count,
1(St~)
Florida. permanenti; . ~ .
• .
• ~ .
s
_
S~ ~~R~GPolz~
IAddrMd 1~
Sworn to and subaeribed before me this ~ daT of 4'o R ~ L U ~l t . ~ Z ~ . 33 7S~
.
l'~?G!o.,,r . A.D.1$~~. .
ROGER PO1 TRAS. GIERK OF G i RCU I T COCdF2T
sT. tE couNTY, ftoR~ _
BY : ~ ~
EPUTY LERK
~ ~1~ ~
Ar,~ F,,.~, 7t '2