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Dectaration of Domicile and Citizenshi
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so~.~~ ~ .
TO TIC CLERK OF T~ CIRCUIT OOURT.
ST . L UC 1 E CpUNTY. ~,O~A;
This b mT dselaratioo of Domia7e and Cltiseaahip io the State at Fbrida that I am IDinE this dy is acooedaaoe. and is
eoatormits wlt6 Seetioa 22E.1T. Florida Statutes. /
I was f
~ a ieKa1 rasideat of - ~t ~ ~ sad I
ICI41 18tw)
resided at _ •.~~~~7 ~ ~ - Sowever. I haw changes ms aomide to
6q+Nt ~d Nasbwl
sad am sad love been a bona fids:eside~ ottbe State e[ Florida ainoe c~ ~ ~ dos d
S~c ~o ~ f 79 i1/1.' /l l~roa k 7`c r
.19.,.~,L1,. and I resids at
~S'~ c ~ ST. LUG I Eea..t.edN.m~b.d
- Id41 Counts. Florida.
sad thin statement is to be fates as deelaration of t
tms eitirenahip. actual legd :saidsaos and domiole is the State d Florida.
_ -IP FOR THE PURPOSE Oi ENROLLING IF FOR HOMESTEAD PURPOSES,
CNI~DREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THE 1 R NAMES:
/ /~f ~9~0 SFP 30 a~, ~ 75
- P_ L[ h 0. I~-• /r /L Z ~ FIIEOI~IiC FtCCni,c~
S t. lUC1E COt1~i 1 Y. i t A.
. - RGGER POItRA5
` CLEIUI CIRCUIT CCL'Rt _
G~CC'Rt)1'i RIFltp _ a
_ ~ a/z/i~
I FtJRT~$ CERTIFY that I w91 register at my local address when the tegistratioa boob »open. and eomPls with all i
other regairsments d a legal reeide~ of this State. -
- a
I FITR1'IiEA CERTIFY that I have no iM,eatioa to return to former damieile. and I fntead to remain is
e be~~-G . U C 1 • Ciolaatl. j~
- X71 t
Florida. permanenu; . {
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Sworn to and snbeaibed betore me this '3 G dos of ? T. -S f !
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~O'"`'~~ A.D. iQ,~.._~ ~ 4 iQ E 7T A ~ ~A 2 E
ROGER POITRAS. CLERK OF CIRCUt T COldZT
ST. LUG 1 E COUNTY, f LOR 1 DA
BY: %
_ EPUTY LERK
J
_ AGO Firm 71 22