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t~~c~ara~~~~a o~ Q~~ic~le ~~d ~j~~ze~s~ip
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TO Tl1E CI.EItI: QF T11E CIRCUIT COURT.
ST. LUG 1 E covtsr~r. Ft,onta~:
. ?Aia i~ mr deolantion ot Domicik snd Citizenship in the SYate of Fbrida that I am f+L'n~ tLis di~ in aceordsacc, and in
eonfwmitr rvith Seetion':
23.17. Fbrida St~tutss.
~ 3 was [oC rrlr a kgal resideot of u~d I
. • r~ _~~2i~.w
tesided at Ho+rea er. l Aa~re changrd w~ domicik to
(StRet aad Ih~meer) -
and sm and havc becn a boaa Gde residcnt ot tAe State ot Fbrida sinee '~+y ~
_ 19~ and I residc at `
. ISu+~I wI t:~ii
.~.,~~.r,~~ . , ST. lUG ! E covnty. Florids.
(Gk~l
and t6is statemeat is to be takra u my declaration ot eitiuaship. actual k~al residence and domiuk in the State of Fiorida.
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. IP FOR THC PURP~SE OF ENROLCiNG IP iOR HONEST[/10 PURP05CS~
CNlLDRCN IN SCHOOL~ PLEASE STATE PLEASE CHECK2 ~
THEIR NAMtCS:
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~ ) FURTl1ER CEKTIFY thal I aiil icgister at mp local zddmss when the rr~~tntion books teopen, and oomplr with all
othcr requin•ments ot a Iegal resident of ihis State. .
I FURTHE3 CERTI lhat~j heve no intention to return to my tormer domiule, and I iotcnd to remain in !
• ~ w~/~ /y /1/I«„ $T . I_ U C 1 E County, f
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~'lorida, pern.anen~i~. - ~ .
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C~(/ ~~'~3'?anrn lornd subccriLed Lc(erc mc this d~y ut
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~;~r~ fi: 'R ER F'OI~'12~.S CLCRK OF CIRCUIT C URT
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`j+';~.' .`s> LUG i E GOUfJTY, FLOl21UA , FILEU t~~' ~tE;;uROED
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