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. t« y~..,r r • Y ~ f • ' ' ~'i r~ e r, ~ * ~ ' ~ ~ t .•y I" • C~ ~ Y . , .._i ` • ~..~,C ;..~`..•:I: ! ~_~::6 G..~~~ t„d'r's~...~,-J''t..:;. ~ • / ~ ~ .'i9~U3 ~ 'i U 7'lli~: C[.CltE: OF T11F CIHCUIT COURT, ST. LU~ 1 E _COUN'1'~. Fr.O1:1uA: , . Thf~ b my d: cis~atia~ o[ I)ni~~icilr and Cilizcnship in thc Stnto ot F'laridn thnt I ~~n tiUnq tt~u dar in accordn~c~. and ii~ cou'armity with Scctiua ~"~.17. }'I~~ids Ststutc~. 1 wa~ ~armrrl~ ~ IrEnl resiJcnt ot ~ e- ~ e ___~_._T~~1 and I ICltrl (Statel residcd at Fn ,~,~A ~ 6~~ ' -}Iowevec. I he?vc chanEcd mr domicilc to . (Streat u?d Nun,tr r) ar.d dr:~ and heve 1,~_c~ a'bonn fidc residcnt ot thc St~tc o! Florida ainco f 7 day oi ~ . l~J~~ end I ~cside at ! 9 ' e ~ ~1 ~'~C' J • (Stre~t and tiumGer) `2~ • u~~.~ . ST. LUG I E County. F'lor~ao. tCte~) :nd tfi: stnlc~nent i:. ta I~e tsken a.g my dect:rAti~r. ot c':uer.~hip, e:tual Iegal resid~:ace and dorticilc in th8 State of Flari~a. IF F'OR THE PURPO;.k OF EHROII ING IF FOR ItOt~ESTCAD PUkPOSES~ CHILDRFt~ IN SCltOGt~ PI.EtiSE STA7£ PLCIISE CIIECK: ~ 7NE~R NI?1•t::S: `t s.~. , . , . ~ G ~ ~ . . _ ~~i~ . ~ - ~ ~ I FC?!:Tll~~.'.R Ct.R'fIt'Y t'.:at I v.i;t rr-^,is.^r r.t i-•;; la:rl addres~ H•hen thc srt~stratioa bool:s reopc:n, ar.d co :~pl~- ~rit:~ all E ot}:~t ret,u:rc:arnts c~: ~ 1~~;; c: r•:.:ident of t't:i~ ~:ati. l ' ` I FUF.TiIF::t C~RTiFY tt:: t I havc r.o in:enii~n to mturn to ray forr..~r dornicite, ancl I intcnd to rcr.:~in in ~ ~ Y .S'~, • ~~S . ~T ,_L U L 1 ~ . Cau~iy. ' (Cit7) . ~ }'lori~a, pcrmanenci~. . . 4 ~ ~ ~ -..+~'~~"'-''~~1 , ~ ~U~NTy ? ~ . -~f~~ ~°G " , ~ _ a~r c-r, ~G . ~ w ~ a~ev ; - I ~ } ; ~ (:::.::CI ~ E _ r:~:;;~ ' . ~ ~r~, ~ ~ z ~ ``'"NL'~tiS' f~0 r ~ ' ~ ..~•'F~.° 1t.G,t s~? ~ A,ti .:cut~i ~ Q . ~ SH•orn 2~ n^.+~ti9~1~R~e~! L; fu:c r.;±• t`~:c c'.:~{ at ~2~~ o"~_-__-~~~ 4 ~ ~ V ~ -~~C?=`-~--- ~.Il. 1!1_.~~ iT.u CIE GvU1fTY l~LA. ~ 1104ER ~pITRAb ~ f~~1i'._`•~_E~1).~__i .'i,i, ~.~.~Fi~__~i ~1~!~_~~i_~_~Ot..~+~1~ ~"!~RKC!RL'~11TCOUR "`t - - - - - - - ~~FiEO~.~ ~ `''s~~'~-`-. 1 L f1~Jii I~~~ i Z i:`.: ~.f`~~ J~N ~O 2 n9 PM i ~ '7~ ~ ~ r;~~ ; ` - - -._P ~ . 3~03 ~ ~ - - - ~ ~ -l~i i i_ t'-l 1 r. ~g . . . f ~ ~ BOOK ~~1 PAGE 4~ ` . ~ , ~-.:_.s - - - - L_ .