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Declaration of Domicile and Citizenship
496969 -
TO THE CLERK OF TAE CIItCUIT OOURT.
ST. LUC I E CoUN'i'Y. FLORIDA:
This is ~ declaration of Domicile and (Fti:eashtp in the Stets of Fbrida that I am (tins this dq in aoooedaocs. and in ? i
aoniormit~ with Section 222.17. Fbrida Statutes. I
I was former s legal resident os - ~ and I
Q II~t7) IStatel i
resided at ~ 1r' ~ r - However. I have eban6sd m~ domic~e to ~ ~
18teMt eat Nvmb~r)
and am and have been a bona Sde resident of the State of Florida since ~7 ~ ~
_ ~ ~
l
.19~ and I reside at ~ S ~ ~ ~ G/'~ t
~ ( (Ste.~t and N~bt) !
Po r-~ S r~ L~ C ? e _ ST . LUG I E Count. Florida,
ICa4)
and this statement is to be taken as m~ declaration of atisenahip. actual legal residence and domicile in the State,lo[ F7aridt. . .
IF FOR THE PURPOSE Oi ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE Pt.EASE CHECK2
THEIR NAMESL ~ I
1980 AtlG 21 PK 2 10 ~ _
- FIEED l+1~ FCCOROELO
S ROGER
PO
TRASA'
CLERK CIRCUIT COURj~
RECORD YERIe'tE0 ~
e-__
496969
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- 4
~ I P'tJRTHEB CERTIFY that I ~ register at m~ local address when the registration boob reopen, and eompt~ with all
other requirements of a legal resident a~f this State.
I FURTAEB -CER1'TF'Y that I have no intention to return to mF former domicile, and I intend to remain in
-Count
~ _ (Ctt~)
Florida. permsnensi; .
1
1
s
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[te ILL .n
U . ~ ;
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swam to and subserbed before me t>:;: a ~ aa, of _ ~
~ ~}RrI?vl2 Jo~1eS
- . A.D.1$~.~ ~ ,
ROGER POITRAS. CLERK OF CIRCUIT COCdItT ~
ST. LUG1E COUNTY, FtOR1UA
' ~ ~ ~
EPUtY LERK ~
: - - _ go~x337 PEE 347
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