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TO TNE CLERK OF THE CIRCUlT t70URT. ~
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ST. LUC 1 E ~p~y. pq,p~p~
1'bis !t nU deelae~ttoo ot Doank~ aad Citiseeahip ia ths St~ ot I+'lo~ida that I am !i!~ tht~ dyr ta aeooedana. aad in `
co~toeiaiW? with SeKiion ~22.1T. Floe~id~ SN?tutes. ~
I was t
ne~ a kaai re~idant d . ` ~ I
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re~ded at Hwrorer. I lave eb~aged aqr do:nidle eo
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sad aa~ and bave bssa s booa fids reddsat o[tbe State ct Fbeids siaos / 9l s~'
1~.=~ aad I t+eside at .~,~~~G
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(8b+~t ~d Nwabri
~~s~ ~ re•~~ `e~'~~ ST. LUC 1 E CouAcy. F1ori~da.
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aad !?~is ststeoueat b to be takeu as a~ deelaration of dti~ensbip. +ktw~l legal resideaaa and domic~s in the S4te d Ffoeida.
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IP POR THE PURPOSE OF ENROLIINQ IP fOR 110MESTEAO PURPOSESi
CHIIOREN IN SCHOOL~ PLEASE_STATE PtEASE CHECK: ~
THEIR NAMES:
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C1.ERK Cl~C~~rCOlfR1' G
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Sa ~ 11 a7 AH'75
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I F1JR1`NER CERTIFY that I~1 register ~t my bcal address when the registration books reopen, and oomply with sll
other requirements of a legal resident of this State.
I F~ C~~tTIF'Y that I hs~~ intention to retura to ST
ormer doiracile. and I intend to remain in ~
~1 s_ L U C 1 E , . County.
~ It~ey) .
Florids, permanenti; .
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Sworn to and s 'bed betore me this day ot __~,f-t ~ 6 ~
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. A.D.19 7~
ROGER P41 TRAS, CLERK OF C t RCU 1 T GOl~2T
ST. LUG 1 E COUNTY, f OR 1 A _
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800K 243 PACE
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