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S14'746
TO TNE CLERK OF THE CIRCUIT COURT.
ST. Lt1G 1 E Cp~ry. ~,pRIDA; ' •
This is my de~claration of Domic7e and Citizeasl~ip Ia the Stat~e oi Florida that I am filing this da~ ia aaordanoe, and ~o
conformit~ a-itb Seetioa 222.17. Fforida StatuLes. ~ .
I w•as formerl~ a legal resident of ~~ =~~ , ~ ~• and I
. ~71 lStaW
re s ided at/~ ~ w~ ~ o//-.~ . t Hoa ever. I bave ebanged a~ domie~7e to
(S•.rs~et aad Nombe~ ~
a n d am and ba~ e been a boaa fide resident o! tbe 5taLe oi Florida since - ~ f /92/ dy d
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_ -19 and I reside at ~ -~'..~.' ~ ~ ~~~ ~
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_~' ~: ~ ~,.~ _ ST. LUGI - Count~,Florida,
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r nd this statement is to be taken as my declarstion of citiunship. actual Iegal residence and domic7e in tbe State ~oi Floridi
" IF FOR THE PURPOSE'OF EMROLLING
CHILOREN IN SCFfOOL~ PlEASE STATE
THEIR HANES:
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IF FOR HONESTEAD~PURPOSESi~-
P~EASE CHECK: ~
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1981 J~.~~ 23 P?' 2~ 15
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R('G~i~ POITRAS
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514'746
~ I FLJR~R CERTII~'Y tbst I w01 register at m~ local address when the registration boolcs reopea. ~d compl~ witL aD
~ c~her requirements of a tegal resident of this S4te.
I FURT~iER CERTII~'Y thst I have no intcation to retura to m~ former domidle. and I Intend to remain io
, ,T* LUCIE ~~t~.
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j Fia:ida, permanend~:
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~ S K orn to and sobscn'bed befo~'e me this ~3 da~ ad ~iz t- -s.~ ,., t l u ~.-r ~'~v /t.~1~
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$ ROGER PpITRAS, CLERK OF CIRGUIT COCfi2T
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ST. LUGIE COUNTY, fLOR10A •
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~7~ _ uePUTY I.LERK
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