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' of Domicile and Citizenshi
Declaratton p
496'764
TO TH>~ CLERK OFTAE CII;CUIT OOURT.
ST . L UC 1 E COZJNT'Y. FLORIDA:
This ~ m,T deeLration of DomicDe and Citi>renship in the State of Florida that I am filing this d~ in aoooTdance. and in }
ooniarmiq with Section 222.17. Florida Statutes.
I was formel a legal resident of ~ i $ i .S.T % and I
lCly) 18tae~) 4
~ ~ i
resided Kt - However. I have Changed mT domicile t0
18trMt aed Nambw) '
and am and have been a bona fide resident of the State os Florida since ~7 ~
19~ and I reside at - ~
IStrMt ad Nombr)
~'1^- ~1 Ph c e _ ST. LUG 1 E ~„nti,
lac,)
and this statement is to be taken as mT declaration of r3tizenship. adnal legal residence and domica7e in the State d Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKt
THEIR NAMES:
{980 AUG 2Q AN ~ 39 •
_ FIlEO ANC FECO~k(1i0
ST~LI)CIER
PO
TRASH I
CLE~~K
CIRCUIT COURT
RECORD \'fRIFlEO._-Z~--
496'764
a
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~ _
I FlIRTHFR CERTIFY that I w~71 register at mT loci) address when the registration books reopen. and eomp}T with aU
~ other requirements aE a legal resident of this State.
I
I FURTHER CERTIFY thst I have no intention to return to my former domicile. and I intend to remain in
U C 1 E _ Connt~.
! (Citj) _
E Florida. permanenu; .
LG, ...,~.rs.
^ ; INa~)
- ' •
5wpriNo ` ~ li~tore me this ~ daT of
A.D.1 o -
ROGER POITRAS. CLERK OF CIRCUIT COt~2T
f
ST. LUG 1 E COUNTY, f LOR 1 DA ~
- BY: _ ~ -
EPUTY LERK
. ~ - ~
X337 P~ l8 .
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A(.0 Form 71 ?2