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Declaration of Domi~ile and Citizenship
TO'THE CI.ERK OF'THE CIKCUIT OOURT. •
OOUN7'Y. FIARIDA:
'iliis is mr detlirstion ol DoaJeM aed ChtsensAip ia tM 8tat~ ~ E7orid~ tl?at I~w fiWi~ tAd dq ~ecnrdane~e. and ia
conlormit~ w~ith Sectjoe 222.1T, t'lorida S4tut~s. ~
i Mu formerl ~ k~al resideM ~ ec~s f~ h~ • and I
• (Qt~) t 1
resided ~t ~ L u ~l ~ • Howe~et.1 i~av~ cbaesed m~ danic~e to
lstr~ ~ad NrmMrf -
and am and have been a bona Gde residtnt o~ tbe State oi Florida s[no~ ~ ds~ o~
_ ~~_.~a t ~~a~.t o D - =~e hr- ~ ~v,
~ Idv.a N..t..!
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J / ~ , ~ / (f v L ~ ~ c•ouoc,. Flo~a..
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lAt~l
and this statcment ti to D~ taken as m~ daluatioo of eitizensAlp. setusl ktal resid~ncs and d~micik fe tM Stat~ ot Plorida.
I~ fo: the purpose of enr~llin~
children in public school, please
state their names:
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I FliRTHER CERTIFY that I.v~71 register at m~ loul addreas when tl~e resistntion books reopee. ae~d compl~ .vitA aU
~ other rrq~ircments a( a kgal nsident ol this Statt.
-I FURTHFR CER I~'~ t~t~ hav ao intent~on lo r~eturn to m~ former domk~ snd I jntend to remain iw
1, _ C 1 e S~~ l~~//4 _ Count~.
IC'it~l .
~ Florida, permanentl~. ~ ~'N~ 2'.~ ~ ~ ~
~ rl~~c ~~+t F~ cep~,~t~
~ 5 t Ll1£~ CCUx 7'!. A.
RCG..R POITr:.5
CLfAK CtfGU1T CLUn'
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~ POITRAS CIERK CIRCIIIT OOT~'RT I`:ane - print
S'I' . 'CI E C('~J~~'IY , RIDA
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' - go~~ 373 P~~E 949
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