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~ Deciaration of~ Dornicile ~nd Citizenshi
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eontormicr ,nlcb Seecioa 22Z.t7, Florida sawt~s. ~ -
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~ aad aaa cad haw been s booa tide radd~at ot Lhe SLats o[ Fl~sida si~s ~7 ~
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aod tbb stateunent is to bs takea a~ mqr deeluatioa a( eiti:ea~hip.,
aetnal kaal re~idena asd donoie~7e in tbs State ol F~oeid~.
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I FLJ~tTHER CEATIF'Y that I w~i ngister at my toeal uldre~ whea the registntion boo~ks reopen. and oomplp wrtl~ all
other requirements ot s kgal resideat ot this State. ~
I R CERTTFY thst I bsve no iatention to return to m~ fornur domic~e. and I intend to nmain in
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Florida. permaneatl~. .
fIlEO AND RECORDEO -
sT aOCERC~3 NitAS
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Sarorn lo ~nd scbscribed betore me this day of ~~~0 ~
V A.D.19 ~~l - ~YT~S ot~•5 /~'tC/~~ ±
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My Co~nmission expires ~
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/~urh.rizcd t~ Cd ~ ist oths and OCt a!
•~otory public by 10 U : 936 ond South U R ~jQ ~C~ ~~1~
Co.oltno ~ 1 i9621 Cod~ of Lo-«s, s 49-13 6 i SUG1( f.?VV j
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