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Home My WebLink About0003 fa.''v~~i..-:~,V $~i~~ ~~Vl i t~\.I#~V ~i~.ii `:~.~'L:.~i..~ . • ! c~'! 11; ti f:~"(1 <~\I? c~i?t;!~'tl' '1.:\ Atitit ~S(~iZ. sL . ; ~ 26239'7 _ _ ('U!;'~71'.I~LO1:!l~,1: ~lhi. n~~~ ~I~rl:iratiun ~~1~ 1)un~icilr an~i ('ititen,hi~~ in th.• Siatr c~f I~lartcla liial I:~iu I~!!~~:~ ti~~>: : :~~c<sicl:~itic~.:in~l ic~'ru~ifc~rn~ily with Stctioi~ ~,'.17, i~lorici.~ Statutcs. 1~~•:~s f~?r~t~rrly a Ic~~al ri•siil~ nt at~ ~~.~L'_ ~L° U_ 1 Q/`sZ_---- -,-~~~C~,S'~'Q~~,~lc~s'~-°~.~''.}S: i i ' (c'ily) (Sl:~tr) r~si;ic~l at . I~S~__7~L~~1p~/--5~~~~J`------___. Howc~~er. ! harc cha»~~.d ~a~y ~ita:;~~~~,~: (Slrr~l anJ Kun~brr) :~ne! am a.~~1 ha~~e ucc:n .i bun:~ fidr r~siclrnt of thr State of t~lc~rida sinc~ -_--_~s~._ ~ now ~,r/ / " ` and 1 /residc at ___~C!!._i~~L~ - / , > > ~ (Strcet and h'un,brr) ~ ~ -.1_~~~'-~° S~. LuCie ° - - - _ . ~ Cu~~nty. T'i~~r;:':~. (C~ty) an~l this state~~irnt is to be takrn as m~~ cteclaration of citizen~iiip, artual legal residence ~tnd dot»icile iii t~~:• St:~::• ~f I~Jorida. (tnur: I~rrr a~y prrlinrn! f~~ts, .uch ac vlr ui prupcrly .~r busincu, or tclinyu~thm~nt of cmpbytncnt at funu~r domicilr, temo~al of family to nc~v domicile, purchrsr uf hc~me, ete.) ~ s ~ 1 ~ ~ r e ~ Entering children in school: ~ f ~~l/~/ ~ ~~P/l/~~t/~~-~ ~~/U/1/ ~ ~~'~t/~/ll D~S' ~ y , ~ = ; ct.~'R°+c~c+a un ~ `I - ~ECORO YfR+~tF~„~ ~ 11 1 is ~ ~!'13 ; L 26239'7 - 1}~URTlfi:It CERTIFY il~at 1~vil! registcr ~t rny local address ~vhcn the rcgistration books rcc~~~~ i._~~,' co?nply with all other reiluirements of a legal resident of this Stat~. • I FURTt~f•.R CCRTIF'Y thal I h.~ve no intention to rrturn to my forn~er domicile, and 1 intend to r~,=:::;~; i; ' c p-~- ~ t . Luc ie ' _'~D~! - - - - - t'~,;t: ~ ; FtoriJa, pe~imancntly. (c~~r~ - ' '~,lT"'~ • - ~ o ' 'v ~ , V-;~U;~i:.,, ..~9i ~x:,~ _ - - --IZ~~GC~ i ~ ~~lC(.. / ~ L (1:~ntr) ' •u~~ ~}r . ~.y ~ r~ / ~ . . _ ~ - - _ _ ~ - ~,z~: _ c;~ • • ~ = ~i< (AdJr~~,) . A~~ t~`'s . ~ ~ . ; ~~`''~ti~•` •~c1+~fi~:~o;;~t~~q'~°'~t'I~cct hrfcir~ tnr thi; .•2 d;i~~ of ; ~~~y ~ r ~ ~ =~Cd~~'_~ ''_'y•:,.:uu~~~'~~~...~;~ _ . _ _ - , A.I). ~ ~l 73 xo~,.?? YUZ'CR~.S~Cf_~;RK CIRCUIT COURT - - - - 3 - ~ oK~iB P~ 3 ~ - ; - P y ~ - ~~r j~~ c ] r - ~ (in hc CarrulcJ in :1u~~li..+1: snJ ~~ti; in d I~Ir~I ~~~th ('I:r~. ('itiuil (.'~rurt. and J~.~.ii~.~i: «i(1~ I.~a :5.~r.,~.t 1 ~ ~ r ~ : ~ 3 ~ ~ ~ -r=-~:~..w~"~- ~ ~ ~ _ _ a~: