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Tbls b u~r deelantlaa ot Domi~l~ ~ad Citisea~h[p iu tM 8tat~ o~ I~7arida tbat I aa~ 81~ t~is d~yr iu aooadanos. sad ia
eontonait~r Mitb Sectfoa ~4.17, ~'lorida Stat ~ - - . ,
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I wu t me a le~a! resideat ot ' ~ I
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und am and ~ave beea ~ bona tde resident ut tbs 8tsts ot Fbslda.~na 3~ ` 1 J dq? ot
19~.~ aad I rasWe a! ~~i 5~O L AN 'E.~ .
~ ~ ~ 1 t ~RG.~°,, ~ ST. LUG 1 ~..aN.~ ~tr. ~a
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aad this statemcat is to bs takeo aa ayr deelaratiad oi eitiunship. utud Iegs~ rssidenae and domictie iA tlie Stats at Fforids.
IF fOR THE PURPOSE OP ENROlLIN6 If iOR 110MESTEAO PURPOSESi
CHILOREN IN SCHOOL~ PLEASE STATE P~EASE CHECK: - .
THEIR NAMES: ~ ~
FILEO ANp RECORDEO
ST. CUGIE COtlMTY ftA.
ROCER PbITRA
CIfRK CIRCUIT C~UaT
RECORO 'rER1F1E0..~...~
~ ' - SEt 1 I OZ ~!'I'75
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t FURTHER CERI7FY tbat I~v~i ngister at mr loeal addr~ss when the regu~etittion boolcs teopen. and eomply w?ith ap
other r~quirements of a legal resident ot this State.
t FURTHER that I Isave ao iatrntion to return to m~r fora~er donuciie. aad I iatcad b remaia ia
_ • P ~ e Rc~, ~ S T. L U C 1 E" County.
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Florida. permaneati; .
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Sworn to aad s 'bod before me tAi~ ~ day of ~'Q ~ O~o ~ a Q,
' A.D.I9_ 7S •
ROGER POf TRAS„ CLERK OF C IRCUI T C01~2T
ST. LUCIE COUNTY, FLORIDA _
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. 8o K 243 804
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