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Declaration of Domicile and Citizenship
49'~21~
TO THZr CLERK OF THE CIIiCUIT COURT.
ST. LUC 1 E CO~Ty, ~-I,p~A; -
This is mJ declaration of Domicile and Citizenship in the State of Florida flat I am filing this dal in sooordaace. and in
oonformit7 with Section 222.17. Florida Statutes.
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I was fob a legal resident of /y ~ ~I ~ R~ snd I
resided at ~ ~ GL . - However. I have ebanged m~ domic~7e to
- 18etMR aed Numbw) - -
and am and have been i bona Sde resident of the State of Florida since ~~U~ daj of
a l -19 o v ' and I reside at ~/y ~ /V /GUI S C(JJ~ yC ~f~'~
(8trMt and No~oDr)
1-(~~T f Q C ~ _ ST. LUG I E connt7. F7eriaa.
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and this statement is to be Wren as m~ declaration of ritirenship. actual legal reaidena and domies7e is ibe State of Florida.
IF FOR THE PURPOSE Oi ENROLLING- IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE ~ PLEASE CHECKt
THEIR NAMES:
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HBO AUG 25 AMI 11~ 37
' fsrfL A~(! FrCORpEO
' ST t.tltaf C01~MTY.FI.A.
~t06ER POITRAS
- CLERK gRCU1T CQUR~
I FURTHER CER1'IF'Y that I w~ register at mT Ioes;l address when the registration boob reopen. and ~mPl7 with aU
other regmrements of a legal resided of this State.
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~ I FURZ~R CERTII~'Y that I have no intention to return tom former domiede. and I intend to remain in
_ _ T. U C I E . Count.
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~ Florida. permanenci; .
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(Name)
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Sworn to and subea~?bed before me this ~ ~ daT of T U IZ 1 / ~ ~ C ~ ~ _ ~3ysd
f ROGER POI TRAS. CLERK OF CIRCUIT C01'dRT -
ST. LUGIE COUNTY, FLORIDA - - .
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~ BY:
EPUTY LERK
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- - ~ B ~33`l PA~F T14 y _
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