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S~-, lUG 1 E ~pUNTY. Fjpp~/~;
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~'11~is is ~ deeLu atioo of Doeoi~3ls and Rli~easbip i~ tiN Stag of Florida flat I am tbb d~ is aooordaoos. and ~
. _ cootocmib ..kit Sediob Y28.Ir, >~'lorida - - . - - - - - - - -
s~i¢ ~~~d _ ~ ~e,eS'e andl
i.was f
~ a iegal rssident a[ -
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resid.d at ~ - However. I b:w eDan
jed mv? domii3le t4
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_ . and m and have been a bona Bde resident at the 8tats d Florida aiaoe ~6 ~ d
V~ a S'f
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9~ and I raeide at 3 ~ GLCG.~re/~,e.e /~y~iv y ~
tsd..t aaa t~1+~.1t.d
~ C e _ ST. LUG 1 E Coant,7• Florida. .
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and tbb statement is to be taken as mT declaration d dtisensbip, actual legal residence and domie~e io the State d Florida. .
If FOR THE PURPOSE.Oi ENROLLING IF FOR HOMESTEAD PURPOSES
CHI~OREN IN SCNOOIs-•PI.EASE STATE PLEASE CHECK:
TNEIR NAMES:
4~Chelle .Cet • ~ee~ : -
E; . ' 4~:i115
19T8 AUG 2~ PM 203 -
f~~ P01 RAS~
- - COURT- - - - - - - -
p ,RECORD VERIFiE
I Ft1RT~t C~'Y that I w~71 repster st mg local addtsss when the registration books reopen. and oomph with aD
other regmrementa d a legal resident d this State.
E
I F'UATIII~ CF1iTIIo7C that I bare no intention to return to former domidk. and I intend to remain in
~ T. U C I E Caa~g.
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G " 1~
~ Fbrids, permane~i.
~l~C4ve.C re'c ~C ee~ ,
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3ys~ G~rt.vdp,c arc
Swesntoasd saD.eribed baton me this dad d -
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K CIRCUIT COURT _ ~~~~:u~'i~i~~~„~;~ ~ _ y ~
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ST. LUG 1 E COUNTII, ftOR 1OiA ~ "
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