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Deciaration of Domicile ~ and Citizenship
TO THE CLERK OF THE CIRCUIT OOURT. .
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T6b b aa~? aael.ratba ot nomkil..oa aci~ea.htp ta tb. $t.t. o[ ~'losia. tb.c I.at sNo~ thf. a~,~ lti aeeoedaae.. ana ls
coato~mitp ~riW Seetton 2?Z.~7. P7ocida StatutM.
I~?as t~t a k~al rssid~ot ai ~n..i Y2o e V i~ l~£ , ~h i o ~ I •
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rasided s! ~ A~r ~ T' lS~ - How~we. I Asw ebaahd m~r domicils to
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7Z _C. ~ ST. LUG 1 E Conat~. Ftoeids.
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• and tAis ststemeut b to be takeo ss nyr dseVration of dtheaship. aetual kgal resideaoe and doanieDe in tba State ot Flarids.
Ii POR THE PURP4SE Of ENROLtING IF fOR~HOMESTEAC PURPOSES~
CHtIOREN tN SCHOOt~ PLEASE S~A7E P1.EASE CHECKZ
THEIR NAMESS
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I Ft1RTHER CERTIFY thai I w~i ngister at mr Iocal address when the registntion booi~s reopen, and eampy witb all
other t+equlrements ot a Iega! resideot of this State. •
I t'[)A~THF~ CER1'IFY t~st I have no intrntion to raturn to my fonmr domic~7e. and I intend to remsin in
~•/;~7Z c~ ~ SY . L u c ~ E . Conpcr.
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~ Florida. permanenti~ .
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, ~~0 ~f,b'qd before me tAis day of C ~
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- CLERK Of C IRCUI T COI~tT
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