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Declaration of Domicile and Citizenship
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71b a u~ d~dantis~ e~ Doaele8~ aod Atf~ash~ ia tM &af~ aI ~'joeid~ tfat I as Wias tAb da~ t~ acaordanes. u~d in
cpal~rmit~ ~ 8~etie~ l~t.1t. ~loeias 84t~.
I wu toraoet a ktal tssidtat ~1 .S ]~~SL~n%~r~s ~l C~ , ! V, and I
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rssided a! .L~._~! ~~~~~~D t'1 - Nowt~st. I I~aw edaa~ed m~ docnic~7e to
IstrMt ri 1~M~f
and am aed have ~a a baea 6de residtat at tLt Stat~ at ~7oeida sInw da~ o[
~ R~~ 1 - ll~.ad i e~side at , 1/~ , n~~~ t.
{ 1le~t Nre1.r1
/~,11~_ e ~ , Count~. Fbrida.
lAy1
~nd this statemeet L io bt tektt~ as mr detlaratioe e~ dttunsT~. setnal k~al resid~nc~ snd domicDe In tM State o! Florid~.
If for the purpose of azrolling
children in public school, please
state their nanes:
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1 FtJRTHER CERTIFY that I~rQ1 regiater ~t my iocat address .rhen tAe re~iaintioa book~ reopen, and compl~ .rith a11
other reguirements ot a k~at resideat oi this State.
I FUR ER _ ER~ that I havt no intsntioa to nturn b my former domie0e. and I intrnd to remain in
~..(L,~ ~ ~ Couni~.
tpc~l .
Florid:. pcrmanentl~.
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POITRAS CIRCUIT OOKJRT Na~r~e - print
S'I' . LUCIE CO(JI~'TY , FIIJ
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