HomeMy WebLinkAbout0852 .t~. • ' . . • . ~ • , . . . . . . . ~ ~ - ~ . .
i r ti n mi il n~ Citizenshi ~
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TO THE CLERK OR THE CIRCl31T OOURT. _ ~ ~
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DOVt~Z'ft. FtARtDA: ~
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11b b mp dselara~tioa ot Doa~ieii~ aAd Citiseea~ip ts eM Stat~ o[ Fk~ida t1~at I am L~o~ tbis dy ia soooedasa. aad in
eoatocanity witA Secdoa 222.1T. Fiocida Statvta.
I~s i~ a Mtal rssideet v~ : ki~, c_ oti ~o . _u~dl
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t~id~d at 303n R s c e I?? ~lI ~ d - Av~rt~r~t. I baw ehanpd my dadia'le to
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and a~a aAd hav~ beea a boaa Cde re~id~nt o~tbe St~t~ o[I~tocids siao~ rL+ dy?ot .
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~PrGg,~ ~ ST. lUG 1 E County. Flocida.
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Ii i0R TNE. PURPOSE Of ENROLIING IP i0R NOMESTEAO PURPOSES~
CHItOREN IN SCNO01.~ P~EASE STATE /I,E/lSE GHECK: ~
TME1R NAMESS -
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CI.Ei~ C1RtWT ~4URT
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- Nou 16 10 2o AN'77
I FUR1'FIBR CEATTFY tbst I wr~71 register at my {ocal addr+~ ~rbea ttk r+e~istration booics seopen, aad oompl~ ~rith all
otber esquireraeats o[ a kgal mideAt oE this Stata.
I F'~JR1'HE~ C~ER1'IFY I have ao lntcntioa to retura to m~ tormer do~aia'le. and I intead to nmain in
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FSoridi. permaneod~ .
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Sworn to ~ad subsctibed bctote me this d~y o[
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. A.D.19~7_„ -
~ ROGER POI TRAS, CLERK OF C IRCUI T COU2?'
ST. LUG 1 E COUNTY, f I.OR i UA ~
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EPUTY LERK
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~ AGO Form 7l 2?
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