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. TOTlIE CI+FdtK OFTttE CZRCVIT COUItT. ' ~ ~ . .
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• 7'Ai. b mr a«u?r.tion ot nomktle saa Ciciseasl?ip ia t6e st.a oc Florids eb.t t.m atas tha a.r ia aaad.ooe. .na iR
~oatora~tf~r with Soetioa 22Z.1T. Florld+~ Statut~s.
I Mrat y~~i a kSd ~id~ut o~ 1 C. •~c~~~ ~d i •
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t'~ a~~ ~a~~ ~c ~'t - xor.o~rer, t a.re d~.ased a~r domie~e to
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aed am aad bave been a bous tide residcat ot ths Sbte ot Ftortda siaee ' _._..-.-dar ot
19~ ...aadlre:ideat a:~l~ c . s~ '
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_~~t p. e c c~ ~ _ ST. ~ LUG 1 E Oa+st~. Fbcida.
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~ u~d t1ds:Uteenent is to be takea as s~? dectaratba oi dtiuaship. aetual kgal e~sideaco and doa~ie~o ~a the &ate o[ Fiorida. ~
. If POR THE PURPOSE OP ENROLLING If fOR HOMESTEAD PURROSES~
CHI~DREN IN SCHOOL~ PLEASE ST11TE PI.EASE CHECK: ~
?NEIR NAMESi . ~
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I Ft1R1'HEIt CERTIF'Y thal I w?iU register at my local ~ddrens whca the r~gistntion books reopcn. and eompb with ai1
~ otber rcqnircments ot a kgal raideat oI lhis Stste. .
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~ I R1'IiE CEItTIF`Y that I have ao iatcation to setura to mr former domic~e. and I jnt~nd to rcmaie jn
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Sworn lo~nd sul,xrii,ed trctoro mo thia ~ dar of p;
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~OGER P01 TRAS,~ CLERK OF C IRCUI T COUZT
ST. LUG 1 E COUNTY, f LOR 1 UA ~ • ~
dY t ~ 600K ~5~ PA6f 6 W~ .
CI'UTY LERK . ~ ~ ~ .
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