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S~ LUG 1 E -oovxrn. >~,oxiua:.
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~ ~ d Die aaa Qtia~aabip i~ the State d FleRiaa that I am ~ this dq 3~~semeda~oe. and i~
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. ooe~ wltl Seetls~ 2It.1T. >!'loiida StataR~es. _
/<<t~~tnrn ?mod ~ /hir~?l9a.h sadl
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resided d .~1.L-~ ~ rove - So~ws~nr.I tiaa ehaopd mT d to
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. and am asd Deus been abona sde resideat d the State d Florida si~oe ~ r f` '~_T_/_9r~ ~ d
1R ? 99 _ gad I reside at S U1 r t) s ,~t -
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. and Ibis slatemest is to be talcea as aq deelaratioo d eitirensbiP, aetnal legal resideaoe gad domie~e is tbs Stste d 1:'lorida.
IF iOR THE PURPOSE OP ENRO<.1,IN6 IF iOR HOMESTEAD PURPOSES
G~lt~OREN IN SCHOOLa- PLEASE STATE - PLEASE CHECKS
THE l R NAMESS
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0 ANCG IiE TT A.
P~TRAS
L'IRCUIT l~llR
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I Cb'~1'g'Y that I w~ sew at m7 loni address wbea the r
g~ratioe bodcs :eopea. ~ ~ aD
other reyaisemeate d a legal residea~t d tbfi State.
I F[JAT~ t'Y that I have ao intentio® to rttara to former domir3le. gad I i~otead to remain m
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Florida. pamaneatl,;.
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Beware to sa+d sabaaibed beia~e me this daT -
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ST. LUG1E COt~iTY, ~QIi
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