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1~0 jIiECI.ERKOF?NECIRCUITCOURT,
- s'~, t_ UC t E covrrrx, 1''LORIDA: - -
` Y'his is m~ declaration of Uomic~7e and Citizensbip in the State_ of Florida that I am filing this day in accordance. and is '
_ conformity witb Section 122.17, Florida Statutes.
I aas formerly a Iegal resideat of ~J~cn~~r ~ +uD t S and I
• fG~ty) fsi,se)
r~-~~drd at ~~~5 N• ~Q.\~`-~ No~ever, Y have ehangrd nab domic~e to
f Street aad Numbv) -
n d a.m znd have been a bona Sde resident of ibe State of Florida since ~'-"~++ks~ ~ day od
~~_~_.-.19~~ aad I reside at a~~ WOo f~
• f $vret aad NumbQ)
_ p~c~ ~ L-l~C.,~l~, _ _ ST, t_UC I E County, rlor;aa. .
IQty)
and this stattment is to be taken as my declaration of dtizeaship, actual legal residence and dominle in the State of Florida. _
IF FOR THE PURPOSE OF ENROLLING IF FOR; HOtiESTEAD PURPOSES,
CH I LOREN I N SCHOOt.a PLEASE STATE PLEASE CHECK:
THEIR NAHES:
. J t y~~.>t i ''SY
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t-.pro. ~e..~
l9T9 AvG 21 P!i 2 51 -
aERK ctRCfm calRr
. RECORQ YERIFtEt!
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I :-liRTi%:R C~P.TI:'Y that I .ill re~~-ster at rAy Io:pJ address when the icgistration t~oa4s rropen, and co~p]y F-;t'~ sll
regnirements of a legs! resident of this State. -
I FURTHER CERT'IF'Y. thzt I have no intention to return to ~mv former domicile. and I intend to remain in
. T. U C 1 E _ County.
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