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Declaration of Domicile and Cit~zenship
S10'740
TO THE CI.ERK OF THE CIItCU1T OOUBT,
ST. LUG 1 E ppv~y, ~,p~~;
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Tbls b m~ deelantion oi Domicae and Cttiretn6~p ia t6e Stats c[ ~lozida t}ut I am l~in~ th~s da,~ ia aooordanoe. aad ia
oonformit~ wltb Seetion 712.17. I~lorida Stat~ees.
I wu former s kgal nsident ot T. -~~ ~•- N~ ~-~~ ~ , 'z `~ and I
~a~a ~t ~l ~~ ~, ~'_~z:.~ _ a~-~. i b.~ ~~a ~ ~ io
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and am aad have bean a bona 5de resident al tDs SW,e ot Florida sinae ~~~~ ~ da,~ d
~~ ~ ~~`~ ,19~..~ and I reaide a ~ ~ c~ c= 5 _ '`l ~~` ~~t ; %~r ~r G ~/
18t~.~t ~d NmbKl
r-~- L,,Z ~,_._~~_ ~ ST. LUG I E Couat~.F7oeida.
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and ttis stateme~ i~ to be takea as m~ deelaratioa a[ eitiumhip. adual 1ega1 reaidenae and domidis in tbe Stat~ at Flocida.
" iF FOR THE PURPOSE OF ENROLLING
CHILDREN IN SCHOOI~ PI.EASE STATE
THEIR NAMESt
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If fOR HOMESTEA~ PURPOSES~
~LEASE CHECK: ~
t980 DEC I 6 P!~ i2 ~ 7
FILEO /~NC FEGORDEO
ST.LUCIE COUNTY.fI A•
ROGER POITRAS
CIEfiK CIRCIfIt tCURT ~
RECfiRD \~t•p~~~c ~ .~_ _. _
510'740
I F[JRT~R G~HT'IFIf tbat I wID register at m~ loeal addrw when tbe ngistratjon booi~~ reopta, aad eompl~ wit5 aD
ofber reqnireme~s at a kgal reaident at tLis SLte.
I F~JRTSEft CER1'IFY tbat I 6ave no inteation to retma to m~ fora~er
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Swa~n to and snbseribed befors me tb» f~ dq d
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aad I iatend to remaia in
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A~~;NA c~a i b~
ROGER P01 TRAS. CLERK OF G 1 RGUI T COt~2T
ST. LUGIE GOUNTY, FLORtOA ~
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B,r: ~'Y1~~.
-~EPUTY LERK
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Af,O Form 91 ?2