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TOTlIE CLF.itK OF771E CIItCUIY' COUttT.
" ST. LUC 1 E Cp1)?~7'1(~ FlARIDA: ~
7'bis b my declar~tion ot Domie~c Rnd Gtitirensbip in ibe St~te ot Florid~ tlut 1 am filiag tMs da~ in accvr~d~nce. and in
eoatormitr witA Seeiian 2LZ.17~ Fbrida Statutcs. .
~ _ 1 ~ras ( o~ a kRat residcat of - (L-(~.~.C1j. ~~Ql1 ~ _ ' r 1~_,,, and I
,reswed.t '~5L ~e s I 3~~ s~'f llo..~vet. I 6sve c~fiany~ed m, domieilc to
lStnet asd NYmEMI 1
aad am aad have been a Dona fide tcsident o! the Sute ot Florids sinec ~ E. G p/I.Z 9e r ~y o!
e C e M 1~ P[' , 79_~ and I reside at ~ 6 S l! A! T/ S P ~fJbU ~ ct f
f Q r"
~o r~ 1 prC ~ ST. lUG 1 E~~~=~
1(~t71 ~ CouaiT~ Fbrda~
aad thia statemeat is to be t~lcea as m~r decLntioa ot citiuaship. aetwl kga! midence and domiule in the Stste of Fyorida.
- IF fOR THE PURPOSE OF ENROLIING I~ fOR NOMES~EAO PURPOSES~
CHILDREI~ IH SCHOOL~ PLEASE STATE PtEASE CNECK2 ~
THEIR tlAMQSS ' -
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~ I F[JRI7IER C6RTIFY thae I rv~71 tcgister at mp Mca! adcircsa w•bcn ibe rcgistratioa bo~ks rrof+en, ind comply with sll
-otbcr requiremcnts of a legal resident of this Statc.
FI)IITHE;t ~R77FY lhal I have no intrntion to rctasn to my fornxr domi~tite, and I intcn3 to remain ie
A t~' I~ r'f Q ~ ST . L u C 1 E ~p~y~
lCit~l .
Florida. petmancnti~. .
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