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ro ~ cc.EC~K oF r~ cu~curr couKr. 3'72~60 `
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11b b my deelar~tloA ot Domlcile and Cili~nsbip ia tM State oI ~'{orid~ tbst I~ C~Nas this da,~ ta acoo~da~. snd in ~
~oniocasity with Section 222.17. Fiorida Statuta. ~
I ~ ~rl~ a te~al e+ssideat ot ~ ~ ~ ~ , % ! /
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r~sided st ~ 5~ Ao~wwr. I Aaw eAaepd uyr domteile to
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sad am aad Aave beea a boaa fede resid~nt ot tAe Stat~ otFior~da sIae~ 3 ~y ~
19~„(~Q,. aad I eesid~ at •
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" aAd tA~s statement b b Do takea ~s aqp deetasation ot dtiseaaAip. aetual kgal reaideaee ~nd domia'1e fn tbe State oI Fbcida.
If fOR 7HE PURPOSE OF ENROIIlNG Ii POR HOMESTEA~ PURPOSES~- ~
tNlLOREN IN SCHOOL~ I~LEASE STATE /~EASE CNECK: ~'""'1
T H E 1 R N A M E S S ' _ ~
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C1.ER1( CI~:CUIT CBURi ~
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- ~ - Ju~ I S 12 3$ PM'~7
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1 FURTHER CERTIF'Y that i wilt register at mr bcal addnsa arben t1~ reaistratioo books reopea, and compU, ~itb a11 ~
other requiremeats oi a kgal reside~t ot thi~ State. ~
I FURTHER CE~IFY~htt I ave ~ inteatioe to retnrn to my tormer d~aie~e. and I iutcad to reu~in in
D N ~ V C.Ri $T . L U C 1 E w Coudir. ~
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Sworn to and subscribed before r»e this ~ dsy o! 1~. 1~ I e r ' ;
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A.D.19.Z.7.~ ~ D 1 (?j 3 3~ S~ ~
R G R AS C~ RK OF C IRCUI T COI~tT ~
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