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TOT}lE c~.~:,.h o~ m~if: ci~zcu~•r r..~~u~cT,
- ST'-- l UC I~---~~____ COIJh~r~•. }'t.utttun:
This ic my dc~•la:ation of I)omicife and Citi:r~ship in ti?e Statr uf Fto~ida that 1 Am !iling this day in accordanre. nrtd in
cuntormity w•ith ~ectiun :."~~.17, F'luridA Stntutrs. .
I K•as (orrr.~~rly M~al ~rsident of Y YYl ~t~ ~~1 c.7 and I
.
ICityl (State)
residec! et o2 y~6~ ~ 1~ ~L ~ ss- Hov?-ever, i have changed my domicile to
lSlrrtt and ~tv~+l~er!
snd Am end hav~ bcPn t? hona (idc resident of thc Slnte ot Floridz since J.~- ~'j y 7~ey o[
~N ,192~. and I rrside al S7 .7~ L/~t' 1//' ~ f~'l~~ L'~
(Street ~ad NumAe~
~ Y~ S~ _ 1~( C.,. _ ST . L UG I f County. F lorida,
lCitrl
end this stat~•mrnt is to bc taken as my deciarati~n ot citiicnsl~ip, aetual I~~gai residence nnd domicite in the Stnle of F'lorida.
If F'OR THE PURPpSf. OF Eh'ROLLING IF FOR 1lOMESTEAO PURPOSES~
CHiLOREl1 IN SCHOOIi PLEASE STA7E PLEASE CNECK: ~
THEtR t~AMES:
` FI~ED :.r~~ ~e~1C~O{ROED
- . JC~~ V^~ t Y^~' r~.
. ~ ~~~(15v
'7~ NOV 16 AM i t: 29
C~
~ ii~Crt? i.i;:.!~u; , ~i;~`. .
I FURTftF:it CI~:tZT1F Y th; L I w•ill registrr at m~ l~xal ad~tr.~.s whrn the registratiun books reopep, and enmpty ~~•ith a,Q
othr.r rrquirerr.~•nts o( a legal residenl o! this Statc.
I Ft~RTEiF.~t ('F:iZTIF'}' th~i I ha~•~ no inte•ntir,n !o r~•turn to mti• form~•r dnmici)e, and 1 i:itend lo mm;?in in
- - - - -~-----z.-z U C 1 E---~ County,
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