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D~clarai~a~ o~ ~3o~~icil~ and Cif~z~i~sl~~p ,
. ~1
S13099
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E Cp~Ty~ FI,pRIDA; '
This is my declaration of Domic~e and Gtitizenship in the Stat~e oi Fiorida that I am fling this dsy ia accordanoe. and in
conformit~ w~th Sectioa 222.17; Florida StatuLes. ~
I K ns formerlR a lega) resident oi ,~L~~~~DL' v~/` ~~/~~' ~~~'N~~ and I
It1t71 ~ IStat~)
resided r_t •~~`a ti ~~ ~i~l ~y// Aowever. I have changed my domici7e to
(Stre~et and N~be~
and am and ha~ e been a bona fide resident of the State oi Florida sin ~~ day of
~ -" E' e 1yi.G~1L
--. C - 19~~ , and I reside at ~~ -~% ~~it/-lCv~'C%7j y~~~~
iStseet asd Number)
~'.~'T r-S ~L~/~%~ ~- i~~~ , ST. LIJG 1 E Count~, F7oriaa,
tGYt7)
and this statement is to be taken as my declaration of ~tizenship~ actual legal residence and domic~e in the State of Florida.
" IF FOR THE PURPOSE OF ENROL~LING
CHILOREN IN SGHOOL~ PLEASE STATE
TNEI NAMESL
^ - .~~~'~.~_F . ~.~~E'y .
~ ~~ ,
IF FOR HOMESTEAD PURPOSES~
PIEASE CHECK: i
~ ~
t~ J t~i 12 ~:: 2= I 2
:r: ~ e ~,~~ ~- eu~i o
ss ~vuE rc~:~ciFC~.
RdGER POfTf~l.9 n
C~Ef"f. C:n^GFiI~ ".~~/
, -{~. .~ - ~~ -
513099 .
I FURTHER CERTII~'Y tbat I w~11 registes at my local address whea the registration book~ reopen, an8 compl~ svith aD
other requirements oi a legal resident oi this State.
Florida, permanenu;.
I FURTHEB CERTII~'Y tha I have no intcntioa to return to m~ lormer domict~e. and I intend to remain in
t-~-+ ~r ~~ ~,- ~ 7. L U C 1 E Count~.
' ~Cit1~ .
C ~.~.. / 98/
ROGE POITRAS CLERK OF CiRGUI T COCfi2T
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Sworo to ifld sabset~bed before me this ~? • _
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ST. LUGIE COUNTY,
BY:
FL t OA • _ .
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UEPUTY I.LERK '
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