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4574'70
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5~,. <.UC 1 E OOtIN!'Y. FLORIDA: ~ .
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~;;'T6is is mP dedsration at Domicile and t~eaahip is the State of Florida flat I sin ffit this d~ io'aooo~+danoe. and is
_ _ wit>a Sedioa 2?Z.17, Fiaeida Statutes.
' - I was i~ a le=at:esident et ~CNf~.e,U ~7_ k~~, _ /U~eu.~ ~/n R JAS _ _ and I
ICS) !
resided at ~ ~d %li, ,r ~ tx'~P r t R r n~., ~ . - flowerer, I haw cbanaed m,F domicile to
1Sv.st..a I~lasil+erl -
-and am aadhaw besa abona Ede resident oitbe State otFbrid: since ~G~,bf.(' • ~ dad of
19,~~ andlresideat $~.{.~Q S~F' ~ha ~2.Y~g~
l8tr.d aadTiomb~
S~ . , a ~ J -e. ST, lUG 1 E .
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and this statement is to be Llcea as nq declaration of dtisens>up, actual legal residence ind domid~e k the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF fOR NOMESTEA~ PURPOSESf
EHILOREM IN SCNOOt.r- PLEASE STATE PLEASE CHECKS
THEIR NAMESS
~ l~~e~~~ ~AUL I3p~-Q~l
1 1919 SEP -6 P?~ ~ OS
F EO AMD Bt:CDHOE(1
S ROGER PO
~RASA~
CLERK CIRCWi C
REE01K1 VERIFIED
4574`70 ~ _
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I 9"tJRTHER CERTg'Y that I wt~! ~ at mp local address when the registr:t9on boobs reopen. and oomplT with all
. other regniremeats_d a legal s+esident of tLis State.
I F[JRTIII~ (~RT1fR that I Dave no intention to returA to mT former domicile. and I intend to remain in
_ T. u C 1 E _ Conatl,
- ICit~)
Florida. pe=maneail~-
_ fN.ad
Swor~t.and sobQ~ed belare me this `
G• dap d ~ . -;~~ccce~
i - ..,.....{sue-~ /l.D 1~ ~9 ?ti~~e~i:, . ~ .
R K~~F''CIRGUIT COti2T - lu ~
ST. LUGt E COUNTY'; - L~t1D~1 a~° . --.'.,',°,n-.~ - -
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