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--~~Decla`~~~on--o~~ Domicile and Citizen-ship - - -
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~;;'T6is is alp daelaratioo d Domicaa and Cf~aeaabip is the Sob e[ >~7osida tea I a~ ~ leis dq ~ amaiasa~oe~ aai L
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:e:id.d ate/'` wa- R C C __Haw~e„e.ilia..elat~.dagia¦:a7.a
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_ . and am acid leave bean a bona bde reaideat d ibe State dFforida since ~4 j
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and t>,is statemeat is to be taken a: a~ dee]aratiaa d dtisembip. actual ]eaal :+esideeoe aad dooieSe i t>te State d >Ffoeida.
IF FOR THE PURPOSE OF ENROLLING IF: FOR MONESTEAO PURPOSES
CNILOREN IN SCNOOIa-PIEASE ST/!TE PLEASE CNECK:
TNEIR NAMES:
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I >'t)R'!'JIER (~tT1FY !ba I w~ reEister at ~ Ioeal addrw wbea the :s~ratiea boob ieopea. sae comp)y witti a1 ,
otber_regta d a kcal reaiden! d this_State.
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~ I F[JAT~R G'~tT~"Y tbd I have m ia~eation to return to m1 former domia'ie. acid I mtsni L ~ a
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