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Declarafion of Domicile and Citizenship ~
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511'7'7'~
TO THE CLERK OF THE CIIiCUIT OOURT.
ST. LUG I E opU~y, ~,p~A;
Thjs fs m~ deeluatioa of Domidle and Citisea~hip in t6e St~ate of Florid~ that I am fling thts ds,~ ia aooordanoe, and ia
conformit~ writb Sectioa 222.17. F7orida Statutes, '
I~vas fornnerl~ a legal resident d 5~~.lG , ~{/~ w~v ~2/G and I
1(Sy) fSeat~~
resided st ~~z D D D~ , However. I bave ehaoged a~ domic.He to
(8t~e~t aad Namb~ -
and am and have been a bona fide nsident oi tbe SW,e of Ftorida aina ~ 8 da~ o~
~~~~E~'.~ 19~~ and I reside at ~~~ S~~ ~/~.~T ~l. ~O 7
~u~-~¢T- , ST. LUG I E~~N~~
Count~. Florida.
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and this s4tement is to be taken as m~ declaration of dtiunslup. aetual kgal residenee and domin'le in the State ot F7osida.
" li iOR THE PURPOSE OF ENROLLING
CHILDREN IN SCHOOL~ P~EASE STATE
THEIR NAMES:
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If fOR NOMESTEA~ PURPOSESi
PLEASE CHECK: ~~
t
1980 DE!' 29 pK ~: 19
F~~Ee ~Hr F~coRC~~o
SI.LUCIE COUNIY.F! A
C ERK C R IaT~QUs
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511'7'7'7
I FIIRTHEB CER1'ff'Y that I wrfll register at m~ 3ou1 addreas wben the ngistration boob nopen. and aompl~ witb al!
other rcqnirements of a kgal resideM, oi tbis State.
I FIJRTHER CERTIFY t~t I l~ave no inLection to ntnrn to m~ tormer domie~7e. and I Intend to remain ia
~f' '' _ ~ T,_ j_ U C 1 E Cp~.
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f7orida, permanent~;.
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ROGER P01 TRAS _
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ST. LUG I E COUN?Y, FtOR 1 OA •
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BY: C -
EPUT LERK
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