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Declaration of Domicile and Citizenship ~
43129
TO THE CLERR OF THE CIRCUIT COURT,
ST. LUG 1 E COUNTY. FLORIDA:
This is ~ declaration o[ Domia7s and Citisenship in the State of Fk?rida that I am 51ina this dq in accordance. sad in
conformity with Section 222.17. Fbeida Statutes.
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I was imme~r a legal resident of ~1 t I n ~Fl~l(1')Y ~ UC~(~ Icy and I
. 1(~r) Itttaed
ceded However. I have changed mp domicile to
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sad am and have been a bona fide resident of the State of Fbrida since day of
1l Ir' 1 ~ ,19_~(~, and I aside at
p ltNzwt sad l
~~1(' j- S+ _ ~ C 1 ~ ST. LUC I E Counb. F~a~ida. -
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and this statement is to be taken as my declaration of citisenship. actual legal resid~anoe and domicIIe in the State of Florida.
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" If fOR THE PURPOSE OF ENROLLING If FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL., PLEASE STATE PLEASE CHECK:
THEIR NAMESS
S-~-~ ~ n
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_ 190 APR 15 Pli ~ 10
S R~E~R
P0) A~~
CLERK GRCWT 9fINE
RfElR~ 1'ERIf'tCQ
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I I F[JRTHER CERTIFY that I wi11 register at ap bal address when the registration books reopen, and ~P17 with all
other requirements of a legal resident of this State.
I FUR1~R CERTIFY that I have no intention to return to my farmer domicile, and I intered to remain in t
- _ U C 1 E ~ County,
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Florida. permanend; .
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Sworn to and subsen'bed before me this ~ day of
A.D. l$~
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ROGER POITRAS. CLERK OF CIRCUIT COt~F2T •
ST. LUCIE COUNTY, FLORIDA ~ •
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- - BY: CR ~ .a
EPUTY LERK
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