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TO THE CI~ERK OF ?HE CIRCUtT COUAT. •
ST. LUG I E CpUNTY~ Fi.ORIDA:
Tfiis ~S m,~r deel~uxeion d Donnidls and Citis~~hip ta tl~ State ot I~7aida N~t I~aa t~ tLis d~,y ta ~?coocdanos. and ta
coatoemitr with S~ction ~tB.IZ. Fiorjda 8tatutes. ~
I was i merl~ a kaal resideat d T/Pr .v ~ i u••~ N• S• aad I
- t~ll 18~~t~! ~
resided at S~/ Q G•v : 6,~ AlJE - Ho~rtver.I h~ve cbae~d npr doiokik b
l8awt a~d N¦.e.rl •
aad uaand b+pre beau a bona tide tesideat oi tM State at Florida siaos Su I`/ s,- ~ S~.f ~+U, ~ _
_ 19___.~ snd I redde ~t ~ / G ? ~CJ~ L 7°L • /f/J - .
_ - t8trwt ~ad N~. ~
SG . Pon T' S7' ~u~ .'c,, _ ST. Ll1G I E Couatr,Fb~ds.
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and tAis ataLement b co be taten as my deeLratioa ot eiti~enship. ,?etuat legat reddvnoe and domidie in the Stat~e ot Ftor~da.
IF POR TNE PURPOSE Oi ENROL~iNG If i0R fiOMESTEAO PURPOSES~ _
CHII.OREN IN SCHOOL~ P~EASE STATE ~ PLEASE CHECK: ~
TNEIR NAMES: .
~
o s c. L
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S.t /i o.T~wL .
FitEO MD RfC Y ~
h~~-~ .r G ~ a~~s . -
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~ ~ e ~ REPA~M VERIFIE!?
. . SEr Z I~ ~3 ~N'~5
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I FURTHER CERTIFY that I will register at my local address when the registratton books reopen. and eomply with aU ~
other reqwremeats of a kgal resident oi tl~is State. . ,
i I FtIAT~E~ CERTIFY thst I have no intrntion to return to my former domieile. and I iatend to remain in
~r'z, ~ T f? ~ ~ c, _ $T . L U C 1 E , County.
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Florida, permaneaci; .
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~ , Sw~'ii ~~a, subaeribed before me thi~ ~ day of
~ A.D.1S 75
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ROGER POITRAS, CLERK OF CIRCUIT COURT
ST. LUG 1 E COUNTY, f LOR 1.UA
BYt
. EPUTY LERK
, ~ OK~~~ PACf (
8~ ACO Fane 71-2Z
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