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TO TIIE: CLtiRK Ol~` T11~ CiRCUIT COUIiT. ~
, S'C t L UC 1 E_~ COUNTY. FLOAInAa , .
9'h~s b n~r dcclaration oI Aomicila ~ed Citizcnship in tho SU?to ot I~'lorid~ th~?~ l ~m tiiing thia d~r tn ~aordsnco. ~nd in ;
contormity with Scction 2`.1.17. tlorida Stetut~~. ~ . ; •
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1 w~s tormcrl a lcg~l residcnt oi ,~`~~,.,~.~k t~'' ' i~v
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residcd ~t ~7./-`~ 1~E - l~owovcr. I hAVO ehangcd my domicilo to
. lStre~t v?d Nuraber) .
~nd am ~nd hnve bccn a bonx tidc residcnl oi tF?e Stute o! Flotida sineo .~7 ~~~_T_ ~ day ot
~ ~t , l9 and I res~dc aL ,(f D/ S~' ~ f r. iv / 4.~ .
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~ L i. e i P ST. LUG 1 E ~ Couaty. Florids,
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~nd this stalcmcnt is to be tnkcn as ruy decteration oi eitizenship. aclual legal residcnca and domicile ie the St,ate of Florid~.
IF POR YHE PURPOSE OP ENROLItNG . I~ FOR HOHESTEA~ PURPOS[5j
C!i I LOREN t N SCHOOI~ P~EASE STATE P~EIISE CHECK: ~
TNEIR NANES. ,
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~ fT. t C~E cOUkTY F~
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I FURTIII:R GF.RTIFY ihat 1 will regisler at my local address wl~en the rcgistr:,lion boo}:s reopen. end comply r.ith all
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othcr rcquirc~aenis ot a Icga) tcsidr.nt of this Statc.
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I 1~'URTIIC;t CCRTIF~' that 1 havc no intcntion to rclurn to my fornicr domiclc. and I intcnd to remain in
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