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TO THF: ci.E:ich oF~ Tn}: CIRCUIT CUU[tT.
r_ ST, _Ll1G 1 E COllNTY. FLORIIIA:
Thi~ is my declarstinn ut Ih,n~icile and Citizcnship in the State of t'lorida that I am tiling lhis d~y in acconlance, end in
contormity with Scctiun ::."r.lT. Florida Stntutcs.
I v?a_~ ~orm~~ a legal resident o~ ~ end I
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ICitYI (State)
residrd at _~T ~ . How~evcr. I havo changMl my domicilc to
(Strret ~nd Kutoarrl
•nd am and ha~ c been e bona fide rrsident ot thc Statc ot t'lorida tince ~l day ot
,19_~and 1 resido ut , ,
t and Numl+er)
~y, T_~ ST . L U County, Flurida,
lCit~)
and this statement is to tx laken as rny declnration o! citi~ca~hip, actu:?1 Ic?;a1 rctidrnce nnd domieile in t~c State o[ Floridn.
IF FOR TIIE PU~'POSE Of
EfJROLLIHG IF i'OR HONESTEAD PURPOSES~
CHIL~REN IN SCHOOL~ PLEASE STATE . PIEASE CHECKI
THEIR NAMES: ~
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! I FUIt7'iiF.R CF.R7"IFY that I wi!( re~i1tc. at my kk nl addre•ss v?•hrn thc reRistration books reopen, and comply with ali
~ other r~•quire•nse~nts at n le~;a! rrs'sdent of this titate.
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1 I'U~: i IiF:~t GF:R7't}~'Y lhat I!~.~w• nn intrnliu:s tu n•turn tn r.iv forr.iPr do~ni~ilc, and I intcnd lo mmain_ in _
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