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Declaration of Domicile and Citizenship i
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TO THE CI.F.RK OF THE CIItCUIT OOUItT.
ST. LUG 1 E apv~y. ~,p~w;
T6is 4 m, deelaration ot DomicDe and Cltisensbip in t6e State d Florida that 1 am ~ tl~ da~ in aooordanoe. and ie
ocnformic~ ~rit6 Seetion 222.1~. Florida Sbtut~es. '
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I ~-as tormerl4 s legal nsident ct ~~ ~ t v ~~- ~ h ,~ ` ~~ aad I
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resided at ~~/ ~~f e P~ . Ao~vever, I bsve ebaa~cd ~ domicDe 10
1 .od N~b~ - ` .
and am and have beea a bona fide nsldent oit6e State o~ Florida sinoe ~ L~ ~~!~~ da~ d
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• (8tr.~t aod Numbrrl
~-~~~ e ST. LUG 1 E ~ti.~~,,
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aad Uus statement is to be taken as ~ declaration a~ dtiuaship, aetual kgal naidenoe and domidk in tbe State d F7orida.
" I F FOR THE PURPOSE "OF ENROCL ING I i FOR HOMESTEAD~ PURPOSESi --
CHILpREN IN SGHOOL~ PLEASE STATE rLEASE CHECKZ ~ j
THEIR NAMES: _
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1981 FE8 -2 p!I 2: 23
FILED RNC F!'COt(1rD
SL LUCtF tOUY t Y. f f A.
ROGEfi POITRAS
CLERi( CIFCU-* CCr,;Ri /~
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51S5'78
I FURTAEA CEHTg'Y tbat I wID register at m~ 3oca1 addrai wben tbe registration booln seope4 and eompl,~ wttb aII
otber rsqniremeats d a kgal ~sside~ d tLis Stale. ;
I FUR1'~~:R CF.~iTII~'Y that I bsve no iateatioo to retnrn to m iormer domkDe. aad I latend to nmaia io ~
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Fbnda. permanead;' i
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s..om to ana sob,a,'bea betore me thf, a a.,, a ~~~ 6'C ~ c')~ ~ --~
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ROGER P,~~RA$,, C~ERK QF CIRCUI T COC~tT , =
ST. LUG 1 E COUN'iY, f LOR 1 DA •
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BY:
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g~pK e~4~ PAGE ~•,V
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