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~ectaration of Do~~~icil~ and Cifi~~nsE~~p ~
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TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E pp~VTy~ FI,pRIDA;
This is m~ deelaration of Domiu7e and Gtitizensbip io the SeaLe oi F7orida that I am fling this ds~ in accordana. and in
conformit~ witb Sertioa 2?2.17. Florida Statutes. ~
I R as formerlq a 1ega1 resident oi - ~/'e- G , ~~ a• and I
lCit~) IS•.aiel
resided at ~~ v? r~ Q-a ~°~~ L-~i'~ ~ - Hov~ever, I have cbanged my domicDe to
- IStrrat aod N~be~
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and am and have been a bona Sde resident oitbe State of Florida sinoe p~" ~ L- 3 D day oi
-19~~(y .. and I reside at ~ ~~ ~l r~~~ s~ W ~ +^ ~ ~ -
(Strret and Numbe~)
~. S i• 1--t.t. ~ i~ ~~ , ST . L l1C I E ~ County, Florida.
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and this statement is to be taken as my deelaration oi citizenship. actual legal residence and domicile in the State of Florida.
" IF FOR THE PURPOSE OF ENROLLING
CHIL~REN IN SCHOOL~ PLEASE STATE
THEIR NANESL
~
- ~~
IF FOR HOMESTEAD~PURPOSES~ -
PLEASE CHECKt ~
1981 J~t~ I 2 Jw i~ 3 I .
i~~ec ~!;r ~=cc~a: c~
51. LUC1[ Cp:1N ; Y. f i:..
ROGER POIfRAS
CLERK CIRCli1T CC;;R; O =
~LCCP^ ~ : ~"' . . _ _~ r - • . ~
~
513062
I FURTHER CERTIF'Y that I w~71 register at m~ local address when the registration books reopen, and eomply with all
other requirements of a Iega] resident of this State.
I F[JRTHER CE~iTII''Y thst I have no intxntion to return to my lormer domiu7e. and I intend to remain in , ~
`' ~ J T, L U C i E Coant~,
Fiorida. per~manenu,•.~ ~ ~~ ~ r/~~ '
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Sworn Lo and subscn'bed before me tbis /°~ da~ ~ ~ i -.~ T. (~t_ ~t. ~ e~ ,
~ ~.D._ / 98/ -
ROG R POI AS LLERK OF CIRCUI T COCfi~i T .
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ST. UG I E GOUNTY, f LOR 1 OA • j-
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- BY: ~ . . : .~ j
EPUTY LE K ~ '
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