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LUG 1 E OOVN1'Y. FLpRDpA:
~;,'1~is b mP dedaratioe d Damieiis and t~ess6ip b t1r Stab d 3`7orida that I ass ffiE this dp b aooo~daoo~. and i~
. _ will 8eetioa t8il.1T, Fbida . .
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resid.d at 3 ? 3 2 /o,?~S y.(c c r . _ - Sonwr, I haw elsa~d mP doa~ie3la ~ -
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_ aad aa~ and bw abo®a sae resiaeat dt>te state d1~7orida aba ~ ~ - ~ ~
andlresideat ~ ~0 9 ~ 7 r'~ -~~.c~-~T
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yf ~ rc c ~ _ ST. LUG 1 E co~q.li7arida,
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• aad this sbtemeat is to be taken as nqT declaration d dtisemhip. adnd leEal =esidsnee aad doaoidb b the Stab d 1<7orida.
- I F FOR THE t'URPOSE_ Oi ENROLLING I Z' iOR HOMESTEAD PUR POSE_S~
CHILDREN IN SCNOOL~~PLEASE STATE PLEASE CHECK:
THEIR NAMESt
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I Ft)RTi~ Ck'~l'g'Y that I wID reaistez at mT local address wbea the registration boots reopen. aed oomP1T with all
other rib d a legal :+esideat d this State.
I FOAT~ t~11TZP'Y that I have no bteatioo to retura to former damici-ie, and I iatead to remain is
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s..en. ba.dsobeQ~ed before m. this ~ 7 aa, at ~l r ~ C.~ c e
ROC~t P017R/lS. CLERK OF CIRCUIT COU2T
ST. LUG1 E COUNTY, 1:LOR tO~A - - ~ - - c' `
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