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51.20'76
TO THE CLFRK OF THE CIRCUIT COURT.
ST. LUG 1 E covrr~t. rtioxro~:
This is m~ declaration of Domiu7e and Cituenship in tAe Stat~e of Florida that I am filing this dar in sccordanx, and in
conforraitJ w-itb Section 222.17. Florida Stn '.
I v~~a.s tormerl~ a legal resideat oi _ ~,Y//~ _ /UFw ~E'~'SE~/ _~d I
lCid~1 ISti:,e1
resided at ~O ~L ~ N Tv'v .~, '9~/~ _ _ Hoa ever. I}~a~ e c2~nnged my dornic7e to
(Stree: a~d Nunber) ~"-'
zad am and i. ~ve been a bona fde resident of the State oi Florida since !~ _ day of
OCTp~G3L~/'~ c p •
, ,19 O ~ andIre9deet ~0 a2~2 ~'• €, ~Nr~E~-, /~/C • __
~ (Street and I`~~.•erl
~~ i e~T ~(JG~E ST. LUG I E ~ouDcy, F~o;;as,
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and this statement is to be taken as my declaration of citizenship. actual )egal residence and domic7e in the State of Florida.
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" If fOR THE PURPOSE OF ENROL~ING IF FOR HOHESTEAD PURPOSES
CHIIDREN IN SCHOOL~ PIEASE STATE PL~E/lSE CHECK:
THEIR N/IHES:
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19fl0 DEC 31 P~f 2~ CO ~
.~ FItEC t~C ~: Ct~F~~f D
' ST. LUCIE CQi1N T Y. i t.1.
R06ER POITRAS
CLERK CIRCUti COUB ~
orffRn L'f~"r'~^--
" . . . s~.zo~s
P
I FiJRTHER CERTIFY that I v~.-~11 register at my 1oca1 address when the registration booka reopen. and oomply ~-itb aA
c:her requiremeats of a 1ega1 resident of this State.
I FtTRTHER CERTII~'Y that I have no intrntion to return to my lormer domic~e. and I intend to remnin in
T. U C 1 E , Count~.
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c io~da. per~anenii~.
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SR orn to and subsrn'bed before we this ~ da~ of
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ROGER P01 TRAS, CLERK OF' C I RCUI T COt~2T
~ ST. UG 1 E COUNTY, f L 1 ~A •~,
~ BY: ~' ~
~ EPUTY IERK
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