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Declaration of Domicile and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E COUNTY. FLORIDA:
This is my declaration of Domicile and Citiaeaship in the State of Florida that I am Ring this day in aooordanoe. and in
rnnformity with Section 222.17. Florida Statutes.
I was former a legal resident of ~ / i ~t. ,r ~/'C and I
tC`ttT) lSt~!
resided at 3 1 ~ g r • 6. K r ~ / , _ However. I have cbaaged my domicile to
tt3treat and Nombad
and am and have been a bona fide resident of the State of Florida ainoe ~ . ~ , ~y ~
19 ~ and I reside at /2 ~l S ~ t ~ ~ • ~ ~ ~
• ~ (8tewt and Nnmberl
~ ~ ~ S T . L UG I E County. Florida.
ccuy~ ,
and this statement is to be taken as my declaration of dti>renship. actual legal residence and domiefie in the State of Fbrida.
,
_ - Jf FOR THE PURPOSE Of ENROIt.ING li fOR HOMESTEAD PURPOSES,
CHIIOREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
_ 190 NAR 27 PI4 ~ 46
FlL``EOA~EENDgq1*F~NCOR~ED
SltOGER
POITRASA~
CLERK CtRCUtT~~6
41114
I FURTHER CERTIFY that I wRl register at my local address when the registration hooka reopen. and comply with aU
other requirements of a legal resident of this State.
I F'[JRTHER CERTIFY that I have no intention to return to my i
rmer
d_ o and I intend to amain in
J T . LUG 1 E „County.
ICStyI
Florida. permanentl; . .
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Sworn to and subscn'bed before me this day of
ROGER PO I TRAS. CLERK OF CIRCUIT _ COOT
ST. IE COUNTY, FLORIDA •
BY: _ - •
. EPUT
. t~3~28 ~,~1044 .
AGn Fnrm 71 ?2