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Deciaration of Domicile and Citizenship
~ ~ 51112~
TO T~ Ci.ERR OF THE C~iCU1T OOUItT.
ST. LUC i E apUN'1'Y. gLpxIDA;
T6is b m~ deelaration ct Domie~s aad Cit~enship in tbe State at Flo~ida that I am IDina t6is dq i~ aoooe+daoos. aod is
ooaiarmit~ wKb 6~etion 822.27. P7orida Ststutea.
I was i~r s kgal ' ent ot ~ /J,/~ ~~~~vv~ aad I
~/ l 1 f8t~1~1
resjded at ~/y(
(BtrMt aed N~b~
aad am and bave been a bona 6de resident of tbe 8tats a~ Fbrids sit~oe
~~2 ~~~.~ai~u s~S"/`~
./_
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~av~
Hawener. I 6ave ebanaed ~ doa~ieile to
~/~~~y~ ~ a~sd
c~~/1/iVOn .~~,
~~~H~
LUG I E ~. ~,~
and this stateme~ is to bs taken as a~ dscLratios d dt~en~hip. actual isgal residenos and domieDe ia tbe Stat~ d Fladds.
" li i0R THE PURPOSE OF ENROLLING Ii POR MOMESTEA~ PURPOSE8~
CHIL~REN IN aCHOOL~ PLEASE STATE ~LEASE CHECK:
THEIR NANESS
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1980 DEC 19 A~! ~ 03
.~ . -
' FiIED ~NC FCCOROfD
S ROGER POITRAS~~
, CLERK CtACU1T CGURj~
, _ ~if.:'.GRC ~'EP':li R_.. ~~ ~ -
. 511121
I FUATHEIi CEIiTII~'Y tbd I will register at m~ lonl addres~ w6ea tbe regidration book~ reapen. and eomp~ wltti dl
otber reqaurema~ts d a ksal resident d tbis &ste.
I FIJATAER CERTII~'Y tbat I Lavs no fntentian to ntnro to faccoer domie~e. aod I intend to nm~in ia
, u c ~ E Connt~
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Florida. permane~i; .
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ROGER P01 TRAS• CLERK QF C IRCUI T COC~tT
ST. LUG I E COUNTY, f LOR t OA \ • 1
- - BY:
' ~ PuTY ~ERK
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