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Declaration of Domicile and C~t~zensh~p
4biQ604.
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UG i E OOUIVTY, FLORIDA:
TAis o my declaration of DomicDe and Citizenship in the Sttte of Fbrida that I am Sling this dq in accordance. and in
oonforauty avitb Section 222.17. Florida Statutes.
I avas formerly a legal resident of -s,~riz ~,cr, sad I '
n lClty? (3tataJ
resided at ~ v ~ ~i~ f; ' _~.-~z.~. ; , Hoxevrr. I hevt changed my domic~7e to
IStrNt and Nombar)
sad am and love been a bona Sde resident of the State at Florida since ~ L~ ,qc ' day at
-19 ~ ~ - and I reside at eJ G' ~ ~ _
~ f
4'.L~ .2,r-~ ~ % -sue U s T . 1. uc t t
`&~••t •ed H Cow,ty. Fbrida.
lGbl
and this statement is to be taken as my decoration of citizenship. sctual legal residence and donrieik in the State d b7orids.
'tF FOR THE PURPOSE OP ENROLLING IF FOR HOMESTEAD PURPOSES,
CHIt.OREN IN SCHOOL, PLEASE STATE PLEASE CHECKZ
THEIR NAMES: ~ ~ 1
~ 24 P~f 2~ 16
- FILEQ AMQ l1FCp D
SL LUCIE CQUNIY~
ROGER POITRA~'
CIRCWT COURT
- Rf6dR~ yERIFIEd,_-__
I FURTHER CERTIFY that I avtTl register at my local address avben the registration boob reopen. and comply avitb all
other requirements of a legal rrandent of this State. .
I F[JRTHER CERTIFY that I have no intention to r~etu~rn to my former domia7e, and I intend to remain in
5fi . L U C I E _ County
lacy) _ .
Florida, permaaend; .
• ~ I ~ ~ ,
•Y ~ .
' ~ Mama)
tAdd~ '
Savors to and subscribed before me this day of
v
ROGER P01 TRAS. 'CLERK OF C iRCUi fi COC~2T .
ST. LUGtE COUNTY, FLORIDA -
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