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TO THE CLERK OF THE CIRCUIT COURT.
S] 2444
ST. LUC I E ppU~'ry. ~-I,pi~~; '
This it my declaration oi Domic~e and Citizensbip in the State oi Florida that I am Sling thfs dq in aaordance. and ia
conioriait~ witb Scction 222.17. Florida Statutes. ~
I a ns lormerlR a legal resident oi ~/ n~ d~p /U ~ i~/ ~/0 2/~
and I
(Cit7) llStatd ~
resided at ~ 3 O ~P~~P~2 ~So n ~U fC, , HoRever. I 6ave ehange~ m~ doraic~e t,o
(Stseet aad Namber) ~
and am and have been a bona fide resident of the State of Ftvrida sinee 1 g • da~ ot
~~ U S~ 19.Z~.. nnd I reside at C~ / 7 C. cJ tr° v ~(J uT ~ J~
P~ ~~, ~ 1 ~ . (Street aad Nambv)
T u G~~ ST . L UG t E Count~. FJorida.
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and this statement is to be taken as my declaration of citizenship. actuallegal residence and domic7e in the State oi F7orida.
E~
" I'F FOR THE PURPOSE OF ENROLLING
CHIL~REN IN"SCHOOL~ PIEASE STATE
THEIR NANES:
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If FOR NOMESTEAD PURPOSES~ ~
PlEASE CHECK: - ~~
, - I~I JAN -6 PN ~ 03
FILtO RNI ~! Ct;Htl(:~
ST.LUCIf COU'ifY.FIA.
ROGER POITRAS n
CLERK CtEiCU~i CfuR' //
RECOR.`: \~ RiF+t ;-. ~
~
51.2444
T FURTHER CERTII~'Y ihat I w~7} register at my local address ~hen the registration boob reopen, and eompl~ witb aD
other requiremenb oi a legal resident of t~is Stat~e. .
I FtTRTHER CER1'IF'Y that I haye no intcntion to return to m~ former domie~7e. and I intend to remain ia
,- ST . L U C 1 E .~~t~.
((St~) .
Florida. permanenti~.
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Sworn to and snbsen'bed befora me this ~ daj o[ v
~.D. _ / 98/
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R R POI TRAS, CLERK OF C IRGUI T COt~'2T
ST. LtJG 1 E GOUNTY, FLOR 1 OA •
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BY: \ ,~ ,
~ EP TY ERK
g~3+~s PAGE
(Aadiesr)
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