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D~~lara~~~~ l3vs~icsle and ~i~izens~ip
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TO 171E Cl.£itl: OF TIiF C1RCUIT COUttT. '
S7= L t1G I E ~;pUl~'fy. FI,,p1t1DA: ~ .
' 71iis ta my dc~lsntion o[ Domiuk and Cil'ucnahip ip tAe State ot Ftorida ltut I am Gling this d~~ in ~eroadsace. ~nd iu
conforraity w~itl? 5ecleoe 722.17. Florids Statuta.
~ l was fornxrl~ kgal residcat of G D~f G--, _ . yC~L" !l~Q~ and I
tesided at /JC~Lv
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o{~' //71t/v~ ~ - Hwre~~er. I Aave clunacd m~ domi~ik to
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and am aad have bcen a bona fide resideat o[ ihe State ol Fbrida aince ~ ,,,2~4 ~r ot
.19Js , aed I reside at ~ r rQ /l ~
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(S{rMl~~?6t1YO0el)
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f~1~.~ ~ ~ ST. LUG ! E comcr. FJorida.
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ard this stataneot is b be takcn as tay dee4ratioa ot titiuaslup. Retual kgd Raideaoe aad domicik io the State of Florida.
. If ~OR 1tiE PURPOSE OF EkROLLINC IP fOR NOMESTEAD PURPOSES~
CNILDREN iN SCHOO~~ PLEASE STATE pLEASE CHECKL ~
~ tHEfR HAMES2 ' "
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• I FUFtfIiEE~ CEIi7'IFY that I w71 register at mT loca! address ~rhea the re~isiratioa laoks reopen, and compl~r with all
-oll~cr requiremcnts of a{egal residcnl of this State. -
I~~ R'I'll ;t CEB tha} I hsve no intrnlioa to return lo my fotmer domiule. and I iatcad W rcmain ia
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Fbrida. permancati; . -
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. Sworn to and ~uburilw~! beforc mc this °2 ~'day of
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~ RQGER PO~AS, CLERiC Or C(RCUi T CO T
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.~,i~,r[JG I E COUN7Y, i'l.0[t t UA .
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