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.Declaration of Dor~iclle and Citizenship
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TO TH>s CL>rRK Ui' T~ t!i~tCillT !DbURT.
S•ii. L.,~:~ oovrrr~r. Fzoim~:
This is mT decLratioa of DomidN and ~ in the State of Ffoeida that I sen ~ this daF b aeooedaaee. sad b
eo~afor~nitp with 8eetioa 22S.1T. h7oeida Statutse.
I wu tormeryr a ~ t+esidet~! of di.f:4 ~ I
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resided st Iiawwer. I hen ehaoged nq domidw to
lslrwt sad NoMei .
and sm and have been a bona Ede resident attM State of Florida since ~ `1' dq a[
- ~ T.~ .19_~ L. and I reside at
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and this statement b to be tatea sa a~? declarstion d dtfsenship, setnsl legal :+ssideaea sad doaoicile b the State d F'loridl~. _
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I FURT>IER CERTIFY that I will register at mT local address when the negbtration boolu reopen. and ~mpl)r with aD
other regniremente of a legal resident d this State.
I F[JA R G'ERTIFY that I have no intention to rehun to mp former domicile. aad I intend to r+eaain in
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• RECORD VERIFIED~~~~~
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before me this day of
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Cto ~ a.eot~ b duaieat~ asd a; isipl m.d wRi Ciak Cixoft O~aaet..ed dupiint. will, Ta: Awl .