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. TOTlIP; CI,~RK Ol`TfIN: CIItCUIT COU1tT, ~1t7 ~
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ST. I.UC I~ COUNTY, I~'LOI2InA:
2'.~ts Js my decln~ntion of nomicitc and Citlzenship jn lho Stato ot 1~'loridd ihet I am tiling this day in accordonco~ and in ,
eontarmity with Seclion 2L'3.17. F'lorida Stetutes,
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I was torm~rly Ic~;al rc4ident of ~ 1S~ ~1.'~ i~ e- , j~ e \ j n rJ~'~ and I
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resided t~t f~p L.:.~'d.~~#~' ~ Y~ ' . liowever. I fiave chn~ fied my domicite to j~
. (Slreet and Kumbo~) • 1}
~r.d am and havc bcen u bons fidc resident of ihc 5lnlc of Florida since ~_,i. !.(_T__.~ dey of
, l9 , And I residc xt ~3~0 r`~ ~ rn ~~~'?5 /~,P IV L l)~ _ ~
fi` ~ G~UI CC . (~t snd Numtxr) .
~ ST . LUC. I E County, Floridn,
{Caty) "
and this stntcmcnt is to bc tRken as ~~~y declara:ion oi citiacnship, nciual lc~nl residencc end domicilc in the Statc of Floridn. ~
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I F F'OR TNC PURPOSE OF ENRO~L ( NG I F. F"OR N0~•1~STEAQ PURPOSES~
C{i 1 L~REN I h SCHOOL~ PLEASE STA7E PI.EASE CHECK: ~
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I FURTllF~R CF,R7'Ir1' tF~aL I will re~i~icr at my loca) address when ihe re~,~istration bcr~{;s rropen, and comply ~vith a!1 ' ~
~ othcr rcryuircinents ot a Ie~;al residc•~~1, of t~~is State. _ -
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I FURTII~:t CTR'PII'I' that I I~a~~~ no intcntion to rr.turri to my lormcr domicilc, arid I inlend lo remain in ~
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