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Declaratior~ of Domicile and Citizenship ~
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TO THE CLERK OF THE CIRCUIT OOURT.
ST. LUG 1 E ~pv~y. ~,p~~;
This 4 m~ decluatioa of Domic~le and G'~tir.ensl~ip ia tbe State ot Florida that I am SIIng this da,~ in socordanoe, and is
eaaforrait~ writh Seetion 222.17. Florida Statutes. '
I w-as formerls a Iegal resident at `r~~.,r o<<~ cc~v., , ~~g,~., ~k and I
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resided at 35 ~~ ~~e ~ S~ b: ~4 ~ e , Aowever. I Dave ebaaged m~ domiea7e b
(8tre~t aad Namb~ ~
and am and have been a bona Sde resident of tbe SW,e of Florida ainoe d~ c[
a ~~- •.~ ~ -19 7~ -uidIre~deat ~)_~tl S ~,,...~,.r.~ R2-
`~ lStr..t aad Numb.c)
P~ ~-t S+ ~~• t,. := ST. Ll1G 1 E Connt~. Florida.
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and tLis statement is to be talcen as m~ declaration af citizenship. aduallegal residenee and domicile in the State ot Florida. .
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" IF POR THE PURPOSE O~ ENROLLING IP POR HOMESTEA~ PURPOSES~ ~
CHILDREN IN SCHOOL~ PLEASE STATE PLEASE CHEGK: ~
THEIR NAME52
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1980 OEC 29 Pt~ 3 22
~~ FI~EO ~NC PECORltCO `
ST.IUCIE COUNtY Ft.A. !
ROGER POITRAS
CLERK CtRCUl1 CWRf ,
~ ?fCG'R ~'E : :~ • .. ~~ --- 1'
511820
I F[JBTI~R CERTIFY tbat I w~ register at m~ beil addrtias ~vhen the registration boolcs reopen. and eompl~ wkb a11
other requiremeats a~t a kgal nsident oi thi~ S4te.
I FUBTHER CERTII~'Y that I have ao inteation to retnrn to m~ lormer domie~e. and I intend to remain ia
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Flosida. permanenu;.
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Swosn to and snbsm'bed before me this ~ da~ a[
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C/~ ~~ • _ e.n. is.~ O :
ROGER POITRAS, CLERK OF CiRGU1T COC~2T
sT. ~uG 1 E counnY, FLOR ~ na
BY:
EPUTY i.~ERK
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