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X00 T!~ t~~RK OF T~ CDiCU1T COURT.
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S~. LUG i E ~ OOUN'1'Y. FLORIDA:
'~::'Tbis is *p dar]aratioo ei Dam3eae asd Isbip ~s tb~ Stab of Florida that I am 111iaS this dq io~aooordaaios. snd i~
. _ aoatarmi4 will Seetioa >"~.1T. Floeida Stabtsa.
` ~ • }I.~aa i~ aZKal sssiaeat;a[ S e/ ~,v _ __/L.,~ aadl
tov~ ~
ttla..t..~ Hst~eel
.aad am and bare been abona ~ rcaideat dii~ StsL- of I~azid: siaze g ~ 7 9 _ ~
• ~ 19_,~.. and I realde at S ~ s/ L.,a w -Q- -
~ tBbM~ aso ~a:~o.
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1~ iPf ° St• ~ µ _ _ ST. LUG ! E ConntF.I~'lorida. -
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- aad tins stabmeat is to be taken ss mP doe]uatios et dtisensbip. actual 1e8a1 residents and domie~e in tbs Stets ei I7o~ids.
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If
iOR THE PURPOSE OF ENROLLING If FOR HOMESTEAD PURPOSES
CHILDREN IN SCMOOLs•PLEASE STATE PLEASE CHECK:
THEIR NAMES: -
s- ~ ~ali'~iv lC~orr~ _r~.S .
.
- 199 S~~ 1 I.- PK ~ 04
A R CWtOED
f LA.
I 01 TRAS -
CgtWtiT
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I IR'CEKTiFY that Y w~ segister at a~ local address wbea the registration boobs reopea. sad osmP17 with aD
other regoireme~ d a kgd resident of this State. -
I C,~.B't'g'Y that I bare no iateatioa to ret~aa to n~ ioraier domie~e. aai I iabnd to semaia b
~i~ p~_. U C 1 E CST.
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F7oTida. ~tTID~i
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U ~ .y f i ~ ~ '
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. !GC f ~0 NiY~'. 4~0 O!
I _ ~ - 1~0
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swarae aaa sabsm'bed before aye this daj at ~ ~p~ / i~
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K~~ 'CiRGU1T COURT
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ST. LUG i E COUNTY, tDil? - .
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BY: - ~ a
_ EPUTY 1LERK '
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