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Declaration.of Domicile and Citizenship • .
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500484
TO TSE CLERK OF THE CIRCUIT OOURT. ~
ST . L UC I E , apUNTY. ~,p~A;
This b aqT deeLsatioo d DamicDe a>md Citisenship is the State d Florida that I am i9ing this dy is aeoordaaoe. and is
• ooafocmit~ with Sedien 422.1T. Florida Statutas.
I was i
~ a legal resident of 1~~ r .If li('tlf
1 V~ (~A ~ • , and I
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resided at ~ 3a a V P rc _ F~1~ ~ ~ ~ _Howear.I base ehang.d snT domidl. to {
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and am and bave been a baoa iTde reaident dtbe State dFlorida sins ~E'•+~ ~ ~ ~ ds,T d
~-~e-~ 1 ~ .19~~. aad i reside a ~SCl~ ~ l ~~~n n ~ C .
18trMt oa H®b.rl
~ ~i r t- r ~ _ _ ST . L UG I E Coup. g~oeid~
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and this statemeat is to be taken as mp dee]aratiaa d ~unsh3p. actnai legal rpidenos aad do®ieite is the State d FSocida.
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IF POR THE PURPOSE 'OF ENROLLING Ii fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS
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190 SAP 23 Aft 3' 47 '
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F~LfC RhC FfCOn8E0
~.r" ST.LUCIf COUNTY.FIA.
_ ROGER p01TRAS
- CLERK CIRCUIT COIdRT
Frruhn vEasr~fr3 _ _
500484 •
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' I FURT'HEB t~Tg9t that I w~ register at mP foul address wbea the rioa boots rsopea. and oompip with aD
I other d a legal raodeat d this State.
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T FURTSER CIIiT~'Y that I have sw inteation to return to m1 farmer domiole. aad I isdead to remaia in
• ~ _ L U C t E _ Canat~~
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I Florida. permaneaii; ; ~ s
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- B..ora toaad robeQibed haloes sae thi: a 3 dad d .
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ROGER POITRAS. CLERK OF G IRCUI T COt~12T
ST. LUGIE COUNTY, FLORIDA
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EPUTY LERK ~
800K ~ PAGE ~7 • . ,r .
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