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TO TH~ C.L~;RK OF THE CIRCUIT COURT, 31S252 `
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7'b& is mr declaration ot Doaalcllo and CiUwnship in the Stato ot Fbrida that 1 am C~ting thjs da~r in ~ceord~nee. aod ta ,
ooptora~ity with Sectlo~ 222.17. Florida St~tutes. '
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1 was ior~ a kgd resideat ot 1~~~e.~z-r~- . aad I
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resW~d ~t . ~,4, - - Howovcr, I have eha~gcd my domicilo to
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~?ad am aad havc bccn a bons lid~ resident oi the Stato ot Florida slnce - day of
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1~ • .]9.: ~ and I nside at -
lStn~t and Nuanber)
~`c-~r~.'~ ~C'E . ST. LUG 1 E County. Fiorida,
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and Wis statement is to be taken as m~? declantioA o[ citizcnship. actual legat residenee and domieile in the State ot Ftorida.
IF POR THE PURPOSE OF ENROtLIN6 IF iOR HOHESTEAD PURPOSES~
CHIL~RCk IN SCHOnI~ PIEASE STA7E ~PLEASE CNECK:
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1 FURTIICR CFRTIFY tha~ I w~l regi.~tcr at my local address whep the rcgistratian books reopen. and comply ~v~th all
4 oihcr requircments o[ a Icgal resident of lhis Stale. , -
` I FURTIIE;~ RTI~Y that I havc no intention to rcturn to my iarmcr domicilc. and 1 intend to remain in
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~ Florida, permancnti;.
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~ RnGFfr'~• CL~RK OF C I~CUI T COU2T
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ST. LtK i C COUNTY, f LOR 1 UA - ~ ~
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