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Deciarafion of Domicile and Citizenship
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TO THE CLERR OF THE CD;CUI1' COURT.
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ST, lUG 1 E CpUNTy. F~,pRIDA;
This i~ ~ deeLration ot DomkIIe and Cltjseaahip is tbe State o[ Florida tlut Z am Rlia= thV dy ia aooordaaa. ud i~
ooatosmiq wltb Sect~ioo 2?'1.17. I~7orida btatutes. ~ •
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~ I was lormer~ a kgal nsident ~ - ~'~ aa1I
p1~~~ /~` , 1 ~ f8tabl
resided aL .~O ~` (.~ ~~ ~ . Hopever. I bave ebansed aq~ domie~s to
~j~a~L ~~8tr.~t ~sd I~m~el -
aad am aad bave been a bona Sde rasideat oi tbe State at Florida sinoe `~ -~-~9 da,~ d
19 ~/ - and I reside at /99i ~~ ~/lG~~t~ 1t~`~'~~
• ~~~ ~ . l~t aed N~b~rl
Lt~. _ ST. Ll1G i E ~.~,~
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and tLis statement is to be taken as a~ deelaration ai dtiunship. actual kgal residenoe and domieDe ia tbe 8tate d.F7o~ida.
" IF FOR THE PURPOSE -OF' ENROLlIN6
CMILGREN IN SCNOOL~ P~EASE ST/1TE
TNEIR NAMESS
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Fi~to ~hc F~ caNa: o
st.~uciF cour,; r.E~ a
ROGER P017R;.5
CLERK CIRCUII C~L'~: JT~
F~ C[.h' 1'~ l~if ~r : ~ 1
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I F~JRZ'~~R CER1'ffY t~hat I~vID regist~r at m~ Iocal addreu wben tbe registtation book~ reopen, and eompl~ witb aD
other reqninemeMs d a kgai reside~ at t~is SwR.
I FiJ~iT~R C.ERTII~'Y I luve ~o ~ntention to retnrn to tormer domieDe, and I int~nd to remaia i~
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' Flo~ida. permanem~i • . -
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ROGER PO i TRA$~ CLERK OF C i RCU 1 T COt~tT ~ d~ o~ S
IF POR HOMESTEAD-PURPOSESi~-
PLEASE CHEGK: '
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s..orn to aaa snb.a~bea t~eta~+. me tbi. a.,~ at .
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