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'its I"rlE CL,>•:RK OFTHE CIRCUIT COURT.
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`,~`I'his is my declaration of Domic~e and Citizersbip in the State of Florida that I asa Aiag this day in aocordiax. a_ nil is '
_ conformity F-itb Sectioa.~L.17, Florida Slatules.
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I v: u formerly a legal resident of and I
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r rsi~ied at ~J` No~ever. I have cbaagrd my domia7e Lo
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n d a, zad have been a bona 5de resident of the State o! Florida since t7-'a'r~°'~' 3 t_t?o_~_ day o1
• - ~ 19? ~ and I reside at 3 ~ S• ~ _
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a;,d this stattmeat is lobe tfkea rs my declaration of otizeaship. actual legal residence and domia'Ie in the State o! Florida.
If FOR THE PURPOSE OF EtdROI.LtNG IF FOR HOMESTEAD PURPOSES ,
CHILDREN IN SCHOOLa PLEASE STATE PLEASE CNECK: ~ ;
THE R NAMES.
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1979 AU6 21 PM 2 16
" - ~ flLfjD~EA~N~O RECORDED
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,III~D YER1FtED. ~ ' . _ _
I : t,~ii i i' = zt C~ "i!'Y that I ~J r~~~ster :a r~:y lo~.l .:dd,~ss tiheD the registration lv~o~s r~"open. and comply ~-i.!~ all
' c; r: ,::irer_.ents of a legal resideat of this State.
I f~LTRTnLR thLt I have ao intention to return to my former domicile. r_nd I intend to remain is
- T. U C I E County.
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