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TO Y8B Q.ENC OF?KB CiRCU1T OOtl~T.
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~ b a~? dee4ratio~ o[ Doa~ie~ and C'itnen~?ip ia tM Stat~ ot t~'foeida that I aan 61l~ ttds dq? L~ ~oorda~os. aRd iu ~
artoewit~ w~its Se+etio~ ~2.1T. Fbeida Staiut~s.
I was ~ a le~al eesideat o~ ~L~ y' aad I ~
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e~esid~d at S~'k ~~t. R/jJ 2t nr 5~1. - How~. I hare e6snpd eeq? donlicils to ~
lsttNt a~d Nw~Mt1 • ' .
ud aa a~d ?aw beea s boaa Gde resident aitGe Stat~ a~Ffocidt sinc~ ~,81[~ •/S- dy ot .
.~icit~ ~ 24 Zr • isd I e+esid~ at . Il .S'~r/n' `p ~ f~~v~•
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" aod ttiis statemcat is to ee takcn as ayr declaration ot ati~eaat?ip. aetual k~al e+esideace sad doa~ic~e in tM Stabe ot F'iorida. ~
Ii fOR TNE PURPOSE OF ENROLLING Ii FOR HOMESTEAO PURPOSES~
CMtL~REN IN StHOOL~ P~EASE STA7E P~EASE CHECK:
THE~R NAMES: - 1 ~ I ~
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I FVRTf~ER C'ERTIFY that I~n71 register at a~Y local address wrhea tAe registration booic~ :tiopea. and eom~ir ~?icA di
otber reQnirements oI a kgal sesident ot thu Statt. ~
I FURTf~Z CF.RTIFYr t,~t I have oo iatratioa to . retnra to m former damie~e. ind I iatead to remain in
an
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ROGER P01 TRAS,, CLERK OF C IRCUI T COI~tT
ST. L4;G i E COUNTY, f lOR 1 UA • .
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BYs
. E P U T Y. L E R K aOOK PACE
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