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~ Dec~aration of D~.micile ~r~d Citi~~ns~ip _ F
TO TfIE CLTItK OF THE CIRCUIT OOURT~
~T. LIJG 1 E COU'iv'r~r, F[A~un~: ~ 33'~i~~s .
This,b my declaralioa ot L~omk~'k+ and Citheaship ia the Stato ot Flocida tha~ I ua t~ this d~~r io seoordanoe. snd in .
ooatormity wilh Section 7~2.17. FIae:3a Statutes. ~
, I was io~ a kgal resident ot ~ ~~e- , aad I
, I~SV) . l&ate) _
resided at However, I have ~~dnq~r domicile to
(8tewt ~d NaobKl ' ~
aad am and bavebeea a boaa fide resideat ot the State ot Fbri~s dnee tn i~ , i 9 T ~r ~
% 19.__. aod I nside at ~ l a~ (.1,(1~%sLt.~~
a:;¢.n c~~ . sT. ~uc ~ Esa~.`..aHa.e.~ _
~ Couat~ f'{o~ida.
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~!!d aliS l~itC~llt ~ t0 bO Li~IBR u U~ I~AC~iTa11CD O~ !~t!lQAS~I+p~ ~11v ~E,gi~ ~QDle iIId d01!l1C1~}E ~D ~ sf#~Q O~ ~i. -
If F4R=TNE PUltPOSE OF ENROLLING • -Ii POR HOMESTEAO PURPOSES~
CHILDREN IN SCHOOLy PLEASE STAtE PLEASE CHECK: ~ ~
THEIR NAMES:
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~ I F'UR1`HER CERTIFY that I~?ill regi..rter at mT loc:l address when tht registntioa book~ reopen, and oomply with all
othcr requirements ot a 1ega1 resideat pf this Siate.
I FIJRTHE~ CERTIFY tha I.have no iatention to retum to my fora~er domicile. `and I intead to remain in
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i Fbrida. permanenti~ . ~
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. . (Add»ss)
Swon to sad subseribed before me this day ot ~~7". ~,jZ ~ ~~~Q • ~
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A.D.19 ~ 6
ROG~ POf TRAS, CLERK OF C IRCUI T GOI~tT ~
'i ST. LIjC I E COUNTY, f t_OR 1 UA
BY: ~ C ~
EP LER
C~tR~l PA~E ~
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