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D~claraf ion ofi Qo~~icil~ a~d Ci~i~~c~s(iip i
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TO THE CLERK OF THE CIRCUIT COURT.
ST. L UG 1 E Cp~Zy~ ~-I,pRIDA: '
This is my declaration of Domic7e and GStizeaship in the State of Florida that I am Aing this day in accordance. and in
coaformit~ a~tb Scctioa 222.17. Florida Statutes. ~
I a as former]q a legal resident of ~~ O~~ f ~ 1' 1 1 C~ and I
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resided at -7 ~%~~./ •~ o~.c o ~~ Hov~ever. I have changed my domic7e to
(St~ett and N~~a)
and am and have been a bona 5de resident of tbe State of Florida since day at
=19 , and I reside at/I~~~~~ ~ c~u- ~ S~ - l~
~ (Stmt aad Number)
C~ ~ f5-L~ ~f~S-~` ~> ST. LUC I E Councy. Ftoriaa,
((~h) ' .
and this statement is to be taken as my dedaration of citizenship. actual legal residence and domicile in the StaLe oi Florida.
" IF FOR THE PURPOSE OP ENROLLING
CHILOREN IN SCHOOL~ PLEASE STATE
THEIR NAMESL
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I F' FOR HONESTEAC- PURPOSESi -
PLEASE CHECKS
1981 JtiN ! 3 P~ ~: I 5
FILfC tNC F~CQNpt;1 -
S1.tuCrF CCUNIY.Fl.„.
ROGER POITRAS ~
CLEF3S ClRCUii CQURI
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s~ ~3~s
I FURTHER CERTIFY that I~t71 register at my local address v~hen the registratioa books reopen, and eompl~ with all
other requirements of s 1ega1 resident of this State. ~
I FiJR1'HER CER1'IF'Y that I have no int~ntion to return to m~ former d~miu7e. and I intend to remain in
-- -; J T* L U C 1 E .~~t~.
1(St~) .
~orida. permanenti~.
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Sworn tte,~~r~ub~c~a"~d before me tbis ~~ ~ da~ of ~ R-'l~'- ~(~ ,r S~ . C~
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R PO I TRAS, C~ERK OF ~ I RGUI T COC~2T
ST. LUG 1 E COUNTY, FLOR 1 OA~ •
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• ~ /_ EPUTY ~.LERK
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800~~6 PAGE1.~
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