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Zoo TAE CLERK OF TAE CIEtCU1T COURT.
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~'S~is b sq de;Lratim d DamieDs aad lYti:+easLip is tbs Stag a[ Florida tLd I sm mans this dp io~aono~daaea. and is
_ _ oomtermib w&L Saetioa I~.17. Florida Statutes.
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_ - }I was i a resided of
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raided d " T o? ~ h'1~ S v -r ~ _ Aowevet. I Lave ehaasaa mT acmiei'k to
t8t~es~ asd Nam1.r!
. and am and have bees a bona Sde scsident oitLe State d Florida since ~7 d
-19~ and I reside d S~ ~U ~f 4 /aQ~PP C" ~P I ~ 1/_~~
r i8rr.d aad T~lamb~
,Q'7' LS-f. LtC' l ~ _ ST. LUG i E cannt~. Flovias. .
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. and this shteme~ is to be tal~cen as m,P deeLration a[ dtizensLip, actual kgal residence and domia'~e is the State d Florida.
li FOR THE PURPOSE OF ENROLLING IF iOR HOMESTEAD PURPOSES
CHILDi~EN IN SCHOOLS- PLEASE STATE •PLEASE CHECKS
THEIR NAMES.
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_ ~ l979 SEP 17 Pw 2~ 35
LUCI NCOItM~1Y•F~IA•
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I FURTBF7t•GEA17I''Y that I w~ segsster at m1 local address wbea the registration boob reopea. and oomph witb aD
other regoQemeats d a legal resided of this State.
I F[JATBER (~tTg'Y tLd I Lave no intention to return to m7 former domies'Ie. and I iatend to remain in
G o T. U C I E Coimt~.
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Florida, permaacad;.
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Swars is asa sabsQrlted before me tLis daj oI Oi2 % S~, ~ ~ ~ / - -
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K~'~F'CIRGUIT COURT
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ST. LUGIE COl)NTY, DMA .
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EPUTY LERK ~