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4;Z9`791
TO TIIE CI.1~:liK n~ TH~: CItiCUIT COURT.
ST. Ll1G I E couNr~~. ~[.okTnn:
This is my declaretion of numicile t~nd Citi~cnahip in the Ststo of Florida thet I am filinE this day in accord/a~`
e. and in •
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contormity ~vith Scction :22.17. Florida Statutes. ~,r'~~
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I was tormrrl • A le al residegt ot ~ c (C~tY! ' lState)
~7~'Gb h~ _ -
' ~ - • - ~ . Ilowcvor. I have changed my domicilc to
~esided at ...~,r
istreet aad Nwnberl •
~G Z aay ot
n~d am and have been a bona fidc n~sidcnt of thc State of Florida since . ,
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~ .~/G`.s/.s7~i
i~ ~L`
.~)CC' ,19 ° S ~ . and I reside st ~S~ ~d ~umtxrl
> ~ ST . C.UG I E County, Florida,.
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bnd this statement is lo be taken as my declaration of cilizenship. actuallegAl residence and domicile in the St~tc oi F'lorida.
IF FOR THE PURPOSE OF ENROILING IF fOR HOMESTEIIO PURPOSES~
CNILDREN IN SCNOOL~ PLE/1SE STATE PLEASE GHECK: ~
tHEIR t1AME5:
• .__C, r.~CORO~'D
~ . - ~ . ,~^;TY. F~ •
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' ~ 429'791
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I FURTIIER CERTIFY that I will registrr at my local nc'.dress when Lhe r~•f;~•~tration t~cai.s reopen. and comy~ly with all
othcr nquire~t~ents ot a iet;xl resident oi this SCate.
I FURT}IH:;t CE12TIi~1 iha4 1 h~ve no intrntion to rctnrn to my former dornirile, and I intend tu r~main in
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C t E ~ County.
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Florida, pcrmanemi; .
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