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Tt?i~ is roy d~•clar,;ti~~n oi noriicil~• xnd (:itir.enship in tl,~ ~tato oi F lorids lhat 1 am filin„ this day in accoc~lYac~, and in
cuntonui~~ ~~•ith S~ction :t'~!.IT~ Floridu ~talules.
1 N•as fornu•rl~ a 1~•~;dl msidcnt of /~~I~/~ . _ and I
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resided al _ " S• .lIowcver. I hsvo chnngeel ~uy domicilc to ;
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and am r.nJ have IMCti a l,ona ~idc resident oi ii~r ~iatc af F'loricla sinte day of
lslS~y 1~ 19~, nnd l rc.side at 4~~ ~
(Sttret ar.d J:uwt.er)
~~a P~ ST. LUC 1 E Count.y. Florida,
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and tF.is sfntemeni is to i~a taken es my dec;arr.tion o! cit:z.mship. actual legal residence and domicile in tl~e Stnt~ o! Floridn. !
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I F FOR TKC PURPOSE OF f.NROII I~1G I F FOR HOt~tESTEIID PURPQSi~S~
CHIIbREN IfI SCNOOL~ °LEASE ~ThTE i'IEASF CHECK: E
THEIR NANESS !
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I rURT13ER CJ:RTIFl' that 1 will reg~ster at my I.~cul ~ddress when the registration bi~oks reopen. and ccmply with aif
other reryuircmcnL.S af a IeE;al resident ot this State.
I FUItT}IE~ CF,RTIFI thtt 1 havc no ir~trntion to rrturn to m~• former domicitc, Rnd I iatend to rr.main in -
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(Citr) . _
Fiorida, pcrmancati;.
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SH•orn t~, and :;ulsscrihrd h~ farc mc this _ da o( ~ _
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