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TO T! Ik: CLti1tK O~' T11E Cl[tCUIT COURT. . .
ST. ~UC ! E courrr~r, ~.ort~nn: , . .
7'his [s my dcel~ration ot Aomicilo and Citlzcnahip tn tho St~?to of ~yoridt lheL 1~m CJing this dsy in ~eeordenco. ~nd in ,
conformity with Srction 2'2.17, Florida Stetulcs. ; '
, m . • Jlfo~'f~i ~a~o ~ina •nd i ~
1 w~s torm~rl s~ lc~l reaidcnt oi •
ICaV1 lStatel
resided ~?l a~ 3 J~e r S a K - jtowovcr. I hsvic eh~ngcd n~y domicilo to
. lStrs~t ~nd Nuia0er) . ) (
end sm ~ed have bccn a bona (idc residcnl of the SU?to ot t'lorida since f`~ r c~ day oI
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7~ and 1 resido at ~~~S~ ~ •
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~ - ~r~,r ee - - - ~ ' ST. l.l1C ! E Couney. Floride.
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nnd lhis atatcment is to bo taken us my dectsrution oi citizcnship. atlualle~al residcnce and domicilr in th~ St~tc o[ Florids.
IP FOR THE PURPOSE OP fNROLLING . tF FOR HOHESTEl10 PURPOSE5~
CHILDRCN IN SCNOOL~ PLEASE S?A7E PLEIISE CHEtK:
TNEtR NAMES: . ~ }
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' CtfRX Cs,tG~IT COURT ~ . 1
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I FUItTIII;R CF.RTIFY that ) will rcgi.~lcr al my local addresa wLcn thc mgistration boo}:s reoprn. end comply .vith nll ~
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~thcr r~quiremc.nis ot x lc~;al residcnt ot this Statc. ~
I F ItT1tE~ CG1tT1F~' that I havc no intcntion la rcturu to my formcr domicilc, and I intcnd to rcmain in ~
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