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TQ?H6 6LEE~K OF TH6 C1RCUIT OOUAT.
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~1M b aq? d~elaeatioa ot DoinkiM aad Citi~ensi~ ta th~ Stat~ ot I~'b~ida tlu~e I sm 5WK tl~ts da~r ia ao~ardaac~, and ia
~oa~a~r witb Seetio~t 223.1T, l~'Io~fd~ Statuta. ~
I was ~ ~ Mpl rasid~at at I . - ' ~ ` sad I .
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raided at ~ Ao~rtr~e. I iiaw s6anpd my doatic~e to
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~sd am ~ad Aav~ bea a boas Gdo rsaideat oi the Stat~t ot I~laida siaa - da~ ot
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ST. I.UG I E ConAcy. Floc~aa.
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- aod ti~s stacement it to ba takea as aqr darlaratioA ot eittuaahip. actnal k=al r~sldeaae aed domie~e ia tM Stat~e ot Flo~da.
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~i fOR TNE rURPOSE Or ENROL~'NG If FOR HQMESTEAO PURPOSES~ s
CM~~~REN IN SCNOOL~ PLE/1SF STA.TE ?~EASE CHECK: ~
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ROCER P81TIU8 -
CtEitK CIRC111T COORT
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I FUItTHER CERTffY thit I w~l segistee at mT =ocal sdderss w?bsa Lt~e segiatntion boo~csreopea. sad comply wit6 all ~
otiur tequireaneats ot s kg~ai i+esideat of this S4te. - - ~
I F'URTHE~ CERTIFY thst I)u~ve ao inteatioa to return to my forakr ~staicile. aud I iatend ta remaia in ~
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Sworn to and subscn'bed betors me this dRy ot _
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ROGER P01 TRAS CLERK OF C IRCUI T COE~2T _ -
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ST. Ll1G 1 E COUN?Y, f LOR 1 UA •
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EPUtY LERK ~ !
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