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~~D THE CLERK•OF THE CIRCUIT COURT,
S~'. L-UC I E ,coU>~~Tx, FI,oRIDA:
``;~`t•his is mJ declsration of Domic~e and G~ti:ensbip in the State of Florida that I am filing this day in saordinee.•and in '
_ sonfortnit~ a-it6 Section 222.17. Florida Statutes.
v I wrs formerly a legal resident of f.~...~ / ~ ~ , _ / and I
IC+t7) fStstel
n s;ded at _ / ~ /t /1 !I ~ ~ h Iio~ever. I have ebanged m~ domicde to
ISttec~t and Nt:.mLv) - ~J. -
1 n d am :nd have beta a bona fide resident of the State of Florida since ~-l r'1 e ~ day o~i
_ _ _ ;,~11 @-- - 19~._,,, and I reside at /r O 1
~
~ ~ n ~ % L° 1~ ~U e-
(st,titt and ~1amt~l
______~o r S~ Z~I~C i~_ ST. l_1.1C 1 E
ICit~1 -County. Florida,
nd this statement is Lobe taken rs my dec)aration of ati=eaship, actual 1ega1 residence and domia7e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING - If FOR HONESTEAO PURPOSES
CHILDREN IN SCHOOLa PLEASE STATE PLEASE CHECK. f___J
7 HE 1 R NAME S;
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C f~ t\ y
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J a~~ n a~ h~ ~
. 1979 .A)JG 21 P!~ 2.49
• ito aECOR'>EO _
. ~ ~COWITY.FIA.
~ppITRAS
' CINt COURT ` .
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l::'1"I:'Y that I .:ill rebzst~r ::t rry )o:zl sddress v:hea the registration 1v~nks rropen. End cflmply ~•:i'r all
=:cr requirements of a legal resident of this State.
~ I r'I7RTHER CERTIFY that I have no intention to return to my former domic~'1e, and I intend to setrain in
T. U C I E ,County,
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f
C INunt)
~ to s:.3 scL. i~ •_;l be:orc: *r. _ this ~ dsy of l- ~ I ~drtial ~
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F CIRCUIT COLT
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T. LUG I E COlJ~l1Y, ~L4:210A - . a=:,`,
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