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~~~~at'al[C~~l C~~' l..~QCtIEG[IC~' ~tZC~ l~I~if.:C-I~Sllt~~
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E Cp~i'ry~ 1~-1,pRIDA;
This is m~ decLration of Domic~7e and Citi:enship in tbe State oi Florids tbat T am Slin~ this da~ ia aocordmoe. and i~s
coaformit~ ~it~ Section 222.17. Florida Statutes. ~ -
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I a•as formerl a le resident of ~~ ' ~' w ~ ~ ~ ~ f ~ ~`'~ - ~ ~ v ~' ~ ~ ~ ~ ~ ~~d I "
~ 8~ ~
IG"a~1 ~ tStal~
res;ded at . Hoa ever. I bave cbanged m,~ domic~e Lo
~s~e,~a x~~ ~
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End am and ha~e becn a boAa Sde resident oitDe SLate oiFlorida sina ~ ~ ~ ~ J da7 ~.
,19 and I reside at Z/ 7/ ~~ ~ ~~ S`
(~and Numberl
~, S' ~•- , ST. LUG 1 E Countp. Florida,
(cs~)
~nd this slatement is to be taken as my declaration of e~tiuns}-ip. actuallegal residence and domiale in tbe State of F7orida. -
" IF FOR THE PURPOSE-OF ENROLLING ~
CHILDREN IN SCHOOL~ PLEASE STATE ,
THEIR NAMES:
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~
514834
IF FOR HONESTEAD-PURPOSES~~~
PLEASE CHECK: i
~
I~I J~N 26 1~~. ~~ 3 7
~i~EC RNr ~~coRai s~
SROGERCP~~Y F~ a
CLEP,K C~~'C ~? ~ J~
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514834
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I FURTAER CERTIF'Y that I w~ register at m~ local addre.ss when the registration books reope4 and oompl~ with aD
o:her requiremenb oi t legal resident oi thit State. .
I FURTf~R CEATII''Y that I have ao inteation Lo retucn to a+~ tormer domieile. and I intend to remain ia ,
-,-- ST , L U C 1 E , Count~.
lG~t~) .
F'iorida. permanent~~.
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S~. oro to~~if' ~ y .~~ore me this _~ ~ da~ od
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ROGER POITRAS* RK OF' Cy1RCUl T COC~2T
ST. LUG I E GOUNTY, fLOR~'OA
~ +_
BY:
_ vEPUTY I.IERK
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t~a~
a~K 347 PAGE 11?4
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