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______Declarat~on _of__Dorn~cite anc~_~~fizens~ii
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S'~.. LUG 1 E o0vrrt'Y. »,oxme: _ .
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`;'Tl+is ~ aqT dedarstion sd DamkDs and (whip is tbs State of F7osida that I am libnE tlda daT ie aooordana. and is
. _ eoniermit, with Section g?3.17, Fjo:lda Statutes•: - _ _ _
r I was t akpt rssideat d ~.,5.!~ ~Q-~ = and I
. t~V1 tet+~i
However. I haw ehauged mT domic~s to
resided at ~ ~ • -
_ .and sm and haw been abona Sde resident atthe SWe o[)c7orida since 0~ .1. ~ _ dsT d
is 7 g~ and I saside st ~ S'~ S t 1~„1'' hQit.
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' snd this statement is to be taken as nqT declaration ei eStisenship. actual legal residence and domie3le in the Scats d >F9o:ida.
Ii FOR THE PURPOSE Oi ENROLLING IF FOR NONESTEAD PURPOSES,
CNILDREN IN SCNOOLs-PLEASE STATE PLEASE CHECK:
TNE1R NAMESt
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_ I~CORO VERlFlEO
I F[JATSi:.Et CERTII~'Y that I wiII register at mT >ocal address when the registration boobs reopen. and oomph with alt
other regniremeats d i kgsl resided of this State.
I F[JATl~ thst I base m Intention to return to former domia~e. and I intend to remain in
G E Coamtj.
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Swoestoand snbso~'bedbefaee me this ~ daT of ! 6 ~ Lu .a. ~ T C1 L
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ROGER POI'fRAS. CLERK O~ CIRCUIT COURT ~ ~~!!"`i""~ul~,~,
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ST. Lt1G 1 E COUNTY, FLOR 1 W1 - , ~ cs;.~v~~~tl~ r- - ~ _
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