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D~cfara~ion of Dor~icife and Ci~izenshi ~
P
54'7840
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UC 1 E Cp~Ty. ~,p~A: ~
~ This is my deeLntion ot D~omic~7e and G~tizenship In tbe S4te of Florida that I sm Aiag thls dq in uca. danoe, and in
eoatormit~ ~rith Seetion 27'1.17, Florida SLtutes.
I wis formerlv a kgal resident ot -~.U A 6A51+ , 1N D~q a~ ~ i
_ . tiau,~ - ~s~.~.f
rrsided at R•~•
y - Hmvever. I have eha,nged m~ domie~e to
(8tre~t aad Nnmb~t)
and am and have becn a bona 5dt reaident oi the State of F7orida siaoe ~ da~ d
o ~ r o E t(~ 19
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_ and I reside at ~O ~o ~ So, o/4.v J~ ~ dEJt U l~ ~ vrs-
(6tewt ~nd Namb~rl
t~T , t~~ E'~ c 6 ST . L UG 1~ Count~. F~orida.
.
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and this stitement is to be takea as cq~ decLration o~ eitiunship. actual kgal rr.sideaoe aad domldle ia tbe State at Florida.
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, ` iF P~R THE PURPOSE OF ENROLLiNG IF iOR HONESTEAO PURPOSES~ (
CNILDREN IN StHOOL~ P~EASE STATE PLEASE CHECKS ~
~ THEIR NAMESS
~ . ` ~
_ NUY 12 AN ~ 09
4_
F~:~r.wr F~coaoco ~
S HQGER
POI~w?sa~ ~
' CIEkK CiRCUIT CCUFT i
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I FtJRTHER CER'TIFY that I~11 regiater at m~ local address ~vben tbe registntion boab :
eopen. snd oompl~ ..it6 all
other requiremeats oi a legal nsident ~ tbis State.
~ I F[JRTAER CERT'IF'Y that I have ew iatention to return to m fornoer domie~e. and I iatead to remain in
, , - _ u t ~ ~ ~
; (c~t>> . Count7.
~ F'lorida. permanenu; .
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S.vora to aod sabscribed before me this ~ d~ d F T. (~i E'~ c~ ~.n ,
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~ ti...f }h~ 1 . A.L.1~
g ROGER POITRAS. CLERK OF CtRGUI T COt~ZT
~
~ ST. L UG I E COUN~Y, FLOR 1 ~A ~
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~ ~ EPUTY LERK '
' ao~K~~ ~AcE 97~ ~ '
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