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Decl~rat~on of Dom~c~ie and C~t~z~nsh~p ,
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TO THE CLERK OF TN~ CIRCUIT COURT, 3~1`S ~
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ST. LUG 1 E Cpt1N1'Y, F'LORIDA:
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• ThV b my deeluation ot Oomieile and Citisenship ta the Stat~ ot Fbrid~ that I am G1Ing this da~r Ia aceo~d~ace. ~nd tn ,
conlocmity with Sectioa 2~.17. Fbrida Statut~s.
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I ~r~ tarmerl a legai reaident o~ ~ ~~.ld - I '
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tesi:kd at ~?~L'~6..~L' S(~- 2 D 1) - Howe~~t. I have ehaaged my domieile to -
laitMt and Num~l . ~ .
ud am sad have been a bona f?de resideat o[ tAe State ot Florida ~iace ~ dar ot
lY~C;~[.~f'I~PJL _ 18~~.. aad I restde at 31 ~ + i
ISeewt ~.d N.mb~rl ! t
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and this statement is Lo be takea u my dee4ration oI eitizeaahip. adud kgd residence and domicile in the State of Ftorida.
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IF i'OR THE PURPOSE OF ENROLLING • If iOR HONESTEAD PURPOSES~
. CHIIOREN IN SCNOOL~ PlEASE STATE PLEASE CHECKS ~
TNEIR NAMES:
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' I FURTHER CERTIFY that I w~71 ngister at my local address ~vheo the ngistration books reopea. a~d eomPlr ~ith au ~
~ other requirement~ ot a legal resident of this State. ~ " ~
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~T}~ CERTIFY thst I Aave ao inttntion to teturn to my former doretitile. usd I intend to remain in =
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Fbrida. permanenti; . .
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Sworn t~ and subseribed bcioro me thv ~ dRy o[ r f~ Y' ~ T,,,i~ ~F Y i
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1Ay Com~nlssiN~'f ~?ate~ Ay~ R. 918 !n f
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Aoe4ed M.j~~w~n:a~ Fr~ R Y ~
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