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Declaration of Domicile and Citizenship
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510'~82
TO T!~ CI.ERR OF THE CDtClJ1T OOURT.
ST. Ll1C 1 E ~pUNty, Ft,pRIDA;
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T~is b aq dee4ration at DomieDs and Cttisenship ia tbe Stat~ at 1~1o~ida t6at I am BSna tliis dq ia aeoord~nos. aad js
coniormit~ wit6 Section 222.17. I~7o~rida Statutes.
I was f~ s kgal nsideM o~t ~~ .°~_ ~<~~p.~-~G l~_. ~ and I
lGt~1 '~ 181at~J
~ u Clt °c> ~c~ \~~ ~ ~ Ha~.e.er. I ba.e ebaaaed m,~ domie~e to
fBt~Mt asd I~I~eb~
aad am and have been a bona Sde reaident at tbe State at Flo~ida sinae \~ ~\~ da~r d
19~.. aad I redde at l o o~ ~r : s~
~ed Nu~b~rl
~"~,r,~-~- ~.T ~v~c ~~~ T~~. ST. LUG 1 E count~.I~9ocia..
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and tbis stateme~ is to bs taken as a~ dee4ratio~u a[ dtiaanihip. utual legal rssidenos aad do~e in tbe 8eate oI Florida.
" IP FOR THE PURPOSE Of ENROILINC ~
CHILDREN IN SCHOOL.~ r~EASE STATE
THEIR NAMES2
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IF iOR NOMESTEAD PUR~08E8~
~LEASE CHECK: ~
~960 DEC 17 AEI i~ 13
~~~E~ aNO ~~cuNa-o
5 ROGER POITRASA~
CIfRX CIRCWT COJ
~ECCR!; L'FR!F{1 f. . _~-_ ~___.
510'782
I FUATEER CE~TII~'Sf tbat I wili ngister at s~ bul addrer wben tbe regi~dration booti reopen, aad eomp~ wltL aD
otber requinmeats a[ a kgal reside~ d tlds State.
I FUATHEA (~:RTII~'Y t6at I l~ve no iatentioo to retarn to foemer domicDe. aod I int~end to remain ia
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F7orida, permanead;.
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Swaeo to aad mb~aibed beice+s me tl~is /~ da~ a[
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R~,~R PQ jJRA$,~ G~ERK OF' G I RCU 1 T COt~t T
ST. ~ LUG 1 E COUNTY, FLOR 1 OA •
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~i~~ ~EPUTY I.LERK
BO~K V`t~ PAGE ~~
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AG(1 Form 7l ?2 ~