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Declara#ian of Dc~r~i i ' ' '
c le and ~~#izenship
To THE GLERK OF TAE CIRCUIT COURT. 4t•~b'~63
ST. RUC 1 E COUNTY, FIARIDA:
This is my declaration of Damic9e and Cttzenship in the State of Florida that I am fling this day in aoeordana. and in
conform:»y with Section 222.17. Florida Statutes.
I wan formerly a legal resident o1; ~ . ~ ~ and I
(~7) l&atd
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resided at ~ ~ ~ AZ--V V ~11r l Aoweves. I have changed my domicile to
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and am and have been a bona fide resident of the State of Florida ainee ~Q~ ~ day of
'1 q .19~, and I wide at ~OC~`1 e.~ ~ ROC?~ -
• (BtrMC and Nnmb~r)
Pl ~ V t'! ~ ST . L uc I E County. Florida.
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and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Fbrida.
IF FOR THE PURPOSE OF ENROLLING IF FOR H~ME$TIE,AD PURPOSES, i
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS ~ i
r.
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~ - 1980 Ault; 19 P14 4~ 29
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FILEO ANC FECOItt3FQ
ST.IUCIE COUNi}.itA.
ROGER POITRAS 1.
CLf1U( CIRCUIT CQL~tT ~
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I FURTHER CERTIFY that I w~71 register at my local address when the registration books .reopen, and ~mpb with all
other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
U C 1 E .County.
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Florida. per~manenci;.
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Sworn to and subscribed before me this ~9 day o! ~ Ple VC's . ~ I
. -A.D.1 ~ A,~AN C~ 71`1M/C M. C~uIbRrT~j
ROGER POITRAS, CLERK OF CIRCUIT COC~2T
ST. LUGIE COUNTY, fLORtOA
~ ~
BY: >
EPUTY LERK
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~.f;n Fr.~ 7t
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