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• ~''1'his is ~ dsehtsstioo of Domie~e and Qtia~asLip •fs tLe State d ~7osida tLat I am ~ tLis dp is~aaoo~daaes. iad b
eoafar~r wklt SKtioo t?Z.1T. Floirids Stai~des. .
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' }I waslacmer a1~ resideatq[ - {staW
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:asided ~ ~ /~O / ~~iYIV,G/ ~ - - - - So~we~es. I Law cLaased mT doadeila b ~ -
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.and amsad lswbesa abons5dssesideat ottbeState aiFiosida siaoe - ~ °I
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• and this statement ~ to be tal[ea as ~ deelaratioe d dtiuaaship. actual kEal resideaoe and domid~ io`tLa State d.1:'iorida.
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Ii POR THE PUR?OSE OP ENROLLING !F OR NONESTEAD-PURPOSE
CHILDREN IN SCHOOLS • PLEASE STATE PLEASE -CHECKa•
THEIR NAMES2
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I F[JRT~„R C'EItT)>:'Y that I w~ segister at m7 local address when the segistration boobs seopea. sad a°mpi7 with aD
other regniremenls d a legal reside. d this State.
I (~'Y ao intention to ret~nra to former domio'k. and I intend to remain is
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B+~arate and sabaa~°bad beiols me this d dsT d ' ~ ~
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