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Declaration of Domicile and Citizenship ~
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T4is d aqr declsration ot Domie~s and (Ytiseasbip is tM stat~ o~ ~'loeid~ thKat I aoA 61ia~ tliis dyr ta ~oeoe~dsna. and in
ooatamit~ ~ritA Seettoo 227~.17. E'lo~dr? Statut~s. .
I waa t
mo~erl a legaJ e+e~ident d ~ I
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t~edded ~t - Howw+r. I haw eLaa~ed nq? doania'ls w
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aod ua and hsve beea a booa tids resident ot tbe 3est~ o[ F'lorida siua P~ " p~ d+iJ? o[
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Pf' e ST. LUG i E cou~~, tnoc~a,,
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- aad thL stateaoeat is to be taken as aqr declaratioa vt dtisensbip. sdtu13e6a1 re~ideaoe aad domiei1e jn tbe 3tate ot F7oeids.
~f fOR THE PURPOSE Of ENRO~LING IP fOR HOMESTEAO PURPOSES~
CH I I.OREN 1 N SCHOOL~ PI.EASE STATE PLEASE CHECKS ~
THEIR NAMES:
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I FURTHER CERTIFY that I w~71 register at m~ local address ~rben the registratioa books rcopen. aad eomplr with all
; other requirements ot a legal resident ot tbis State. -
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't I~'iJR't'~iER C A tl~t, I have ao intrnGon to ntnrn to m tornur domieik. ana I intend to remain ia
f ~o i P!' C' _ ~T . L U C 1 E . Couniy.
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~ Fiorida. permanemi;. ST~IUC~f D OUNTY FlA•
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` Sworn to and~aUbseribed be[ore me tAb day ot P/' O/'~ d .
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~ RQ~G~~ PQ~t=`•'~~,tAS ~~_6~.ERK OF C IRCUI T COU2T
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ST`:r::~~k~C~L: ~DUM'[~`s f L.OR 1 OA
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BYs~~'• '
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UTY LERK
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