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Declaration of Domicile and Citizenshi
P
4~I)646
TO THE CLERK OF THE CIRCUIT COURT
sT. Luc 1 E .
This is my declaration of Domie~7s and Citizenship in the State of Florida that I am fling this dq in accordance, and in
conformity with Section 222.17. Florida S4tutesp~
I was formerl a kgal resident o[ ~ y > > y ~f1 ~ I
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resided at _ ~ I ~ f' ~ `i ~9(~R /C _D,,~? . However. I have changed my domie~7e to
1~ and Num~l ~
add am and have been a boas Sde naideat of the State of Fbrida since , x ~ day of
~ L .19
~
S - add I reside at ~ ~ / ~ ~~Cc.+ ~ /'A/9 ~1'/ P w , S L~ .
t8treat sad Nombar)
C f / .S 7: [i C_ i ~ S T . L UC I E County. Florida.
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and this statement is to be taken as my declaration of citizenship. actual legal resideaoe and domia'le in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSESs
CH1t.DREN 1N SCHOOLS PLEASE STATE PLEASE CHECKS
THE t~Rj N`A MfyE//S : C /J v
1980 LIAR 24 Ply ~ 00 -
FtLEO AND PEC01lfED
ST.LIICIE COUNTY.ftA.
R06ER POITRAS
0.ERK CtRCUR~C011RT
RECtlR~ YEP.lFIEO_~ _
40646
I FURTHER CERTIFY that I w~11 register at my local address when the registration books reopen, add comply with all
other requirements of a kgal resident of this State.
I FURTHER CERTIF'lC that -I have no intcatson to return tom former domiei7e. and I intend to remain in
U G I E ~ County.
• 1(St~)
Florida. permanents; .
v
COUNT
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v'• 3/a Nun aQoa-dvie~.' S? -
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.
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Sword to and su before me this ~ day of
cite A.D.19,~~ K ~ iT~l ~ NgQk~AIS
ROGER POITRAS. CLERK OF CIRCUIT COC~2T
ST. LUGIE COUNTY, fLOR10A
EPUTY IERK
80
K cX.O t1~E s~ir~i - .
ACO Form 71-22
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