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S'~ LUG 1 E OOUH'i'Y. ~LORIDAs
~:#'T6is i wy derlsratioo a[ Doesio'M and t]tiNmsbip io /M State a[ Florida tbst ~ ~ tiia i+p b~sooord+mes. aed is
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t~'_c~:..cs~. ~ ~ ST. LUGI E -
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aa~d thb atatemsat is so bs talcea as aqT deelasatioa ai e3tisea~sbip, aetaal fetal resideaoe and domid~e hs t6a Stale ed T7orids.
I f FOR THE PURPOSE Of ENROLI. iNG 1 f FOR NOMESTtiAO i~!URPOSESi
CNIt.OREN IN SGNOOL~• PLEASE STATE PLEASE CHECKS ~
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otlbr regaQmmb d a Iesal sesideat d this State.
I p'OAS~ CS~1'g'Y tls! I >tarre aw _iate~ntioe to :etas to mT former domiole. sad Y iatead to semaia is
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