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__~_Sfi, t_«c I E _ ___.~.cour~7•~~. F~.OItIDA:
Tl~i; =s c::; +!t~f~tftel+n~~ c~f TMntiriln and (:iti~~:nqhip in lhu St~ta uE l~~torida that I un filiug t~,is da~c ia acca-dance. and in 1
cunfurmity w-ith Scciion 1~"~.1?. ~ lorid~ Sl~+tutcs. • ~
I was torn:~rl~ a Ic~l cesidcnl oi s~ v
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residi.~ at D~ x/u~ /O~~ (~v~`'` - lio~rc~•cr. I harr cba~rd domicik lo
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and nm and have bee~ a boua tide msidcnt ot tl~c Stete of ~'lorid~? siucc 1Z~ ~ ~ da~ o[ ~ '
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~~.19 7~~, snd I rCSEdc at ~f2 yiV J~'f r1 w!~ C~~n ~ t~fSL~;2lT /k
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t~rent asil~.oserl
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and this statement is to be taken ~s my declaratiun ot eitize~~ship, act?.al tegal resideoce and do~idie in !!r Ctsie ot F2xidL
IF fOR THE PURPOSE OF ENROLIING IF fOR NOJi~STEiD PUn^POSES~
CHIIDREN IN ~CNOOI~ PI~ASC STATE Pt,EASE CNi.GK: ~
THE IR t~ANESS
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I FURTZtER CERTIFY that 1 will mgisier at my local address when the registration baat-s reo~?za, sod co~~{J ~re*6 s~
o:hcr rnquirem~nts of a legal msident at this Stxle. -
I FUftTHER C}~:It'PII~'Y th~t 1 havc na interti~n to mturn to mF farmer dr?m'v~ik. t.nd I ialrad to rrir.aia en
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Sv?o: n tu and ~ubscrifMd ~c[urr mc thi. day o( ! d~~2 T j~~ j~[ "t~
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RU^SCR POt TF2AS,__CLERY pF C IRCUt'!' CpG2T
ST. L U~ ! E COUN ~ Y, F ~Oi21 U,~ '
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