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~28091
Declaration of Domi~~~~ ~~1~ ~itiZ~il~~i~
TO THC CLERK OF THE CIACUIT OOURT. .
U c 1 C~ QpUNTY. FIARIDAs
71is is m~ deelaratio~ ~l DoonieD~ a~d (~ttteoslup is tM 8tat~ ~I !'lorida t6at I am 6lins tl~is dy it ~ooordance. and in
eoaforrnit~ .rtt1 S~etio~ l~t.~T. Fbrida Sbtut~a.
I was tosn~er r a k~al residtst d~~ / V% 1~ G- ~ N//`3"- and I .
1Gtf1 l8utal
. resided at a ~0 ~r T!- c~ ~T Nowever. I Aave c~ae~ed m~ docniei7e to
lBteMt a~i NdmMd - ~ s ~
and arn asd have beee a bona tide residtnt of the State a[ Florida sina~ ~?l ~ da~ d
l_~p ~ ~S ~ .19.~-~. aad I reside at `.~a ~/V ~S
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~7~0 rZ~ L/9 x~,0 ~Z V 1~ . _
o~1T c~~-~ E ~2T S i.
`~~~N~ , Count~. Florida,
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and this statement L to be takeo u mr deeluation of citizenshtp. actual ktal re~idener and domiale in !he State ot Florida.
If for the purpose of ez~rolling
children in public school, please - pg3 ~~j 17 P~$ 3' S7
! state their nanes:
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~ I FURTHER CERTIFY that J w~l register st my loci! address w+hen tAe registratan books reopen, and compl~ w~ith all
~ other requiremeab ot a kgal resident ot this State.
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` I FURTNER CERT'IFY that I Aave no inlention to r,etura to former domic~7e. aed I intend to remain in
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, ~u ~ i ~ . Countr, "
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~ Florida. permanentlp.
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~ S`T . ~ I~1CIE COIJIJIY , FIARI~A
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By ~ty ~ 414 P~~E 92~
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