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Declaration of Domicile and Citizenship
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Thi. a mp aed.esctoa v[ nomkiM .aa t~.asetp ie tl» se.t. v~ Flocia. eAat I ~m min6 thi. dy in .~ooocd.no.. sna is
ooafoeanit~r ~ritA S~etion 222.17. Fio~ida Statut~s. .
I wa~ i s k~at re~ideat d V~' ~od I
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r~ded at .3~~ ~~j ~~~A /d.G /cif - ~wev~. I haw,~ ~U? domia~ to
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and am aad bavs eeen a boaa tde twidsnt o[tQe Stat~ otFbcida sinos ("Ggl~j~'~~~'~T da,~ o[
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snd this satemenc is to as takea as aa~? dse4ratios a~.ati~easl~ip. aetwl k~gal e~sidesa and domic~7q is tLs State o~ Flocida.
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If i'OR THE PURPOSE OF ENROLLING Ii iOR HOMESTEAO PURPOSES~
CHILDREN IN SCHOOL~ PLEASE STATE PLEASE CNECKS ~
THEIR NAMESt -
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CLERK Ci, _CUIT vfly~~'~
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I FURTHEIt CERTIFY that I Mn11 register at my local addsess wrlun t6e ngistration booics reopen. aod oomplr w?;ch•all
; ot6er requiremeats of a kgal resident oi this State. ~
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8 I have no iatentioa to retun~ to m former domicile and I jntead to nmaia in
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Florida. permanenci; . _
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~ Sworn to and aubacn'bed before me this day of ~ ~
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~ ,~tO~E~2~~~I~~3C.~ CLERK OF C iRCUI T GOU2T
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