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Declaration of Domicile and Citizenship
496880
TO THE CLERK OF THE CIItCUIT COURT.
ST. LUC 1 E COUNTY. FLORIDA:
This ~ my deeLration of DomicDe and Citiuaship in the State of Florida flat I am filing this day in seaordanoe. and in
conformity with Seetian 222.17. Florida Statutes.
I was fob a legal resident of ~/-m ~ I
~ la 1 18tat~1
` 1 S ~U _ ~ L'~ ~ _However. I have changed my domie~7e to
resided st ~
18vut and Hvm4r) T
and am and have been a bona fide resident o~ithe State oiFlorida sines day of
` 1F a ~ . and I reside at ~ •
omb.r)
_ ~ _ ST . L UG I E Counh.
ICt41
and this statement is to be taken as my deeLration of citizenship. actual legal reaidenoe and domia'le in the State d F7erida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: !
THEIR NAMES:
p~ a
~0~ ~~G 20 PN ~ { 7 i
- `r FILED /?Nt' FECORtKO ~j
ST.`UClE COUNTY.FIA. +
ROGER POITRAS
CLERK CIRCUIT COURT
RftORD CfR1F1Ft1 _
496880
I I 1''UR'i'I•lER CER1'I>:R that I w~71 register at my local address when the registration boob reopen. and comply with all
other requirements of a legal resident of this State.
I FlJR'I7~R CERTIFY that I have no intention to return tom former domieDe. and I intend to remain in
U C 1 E County.
' 7
Florida. permaaenci; .
_
- ~ ~ r
v -----il~ G
1; ~
'c~~ -CUNiV~C'' Q~asw ,
~ ors?
Sworn to and sab~scn-bed before me Ibis ~ day of
• -~ttM~S I~• ~oUREiE'
C~~c.c.~,~,c~a-~ . A.D. i
_ ROGER POI TRAS, CLERK OF G IRCUI T COC~2T ~
ST. LUGIE COUNTY, fLOR10A ~ - -
_
BY: ~ ~
EPUTY LERK ~ '
.~i~~
~1,~~37 P~~E 198 ~ ~
A (:n Form 71-22