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'IO0 THE CI~R OF THE CIRCUIT UpURT.
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LUC 1 E ~ OpUNTY. FLORIDA: _ ~ -
- - Domic~ and is the State of Floz-~c flat I am fiRar thls ~7 ind is
. oonta~ with Sedioa 222.17, Fjo~ida Statnt~es. _ -
L~TITZ PA aadl
• }I was former) a legal resiaeat e[ - 1tyj1. - - t~
Aoweer.ILa~recLangedr+~ alto
zed st t8ts~d. aai?iasLrel - -
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.and am and Lave been abona Saansiaeat attbe State adFbtiaa s'~
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"at TlBtr+da~dJ1!o~mbs~ _
- ST. LUG 1 E Connt7.1:7oriaa.
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aaathis statement ~>4 be taken as mY aeclaratioa ai eiti:enship. actual legal resiatnoe ana don ~ the Stste o[ Florida-
. - ,IF FOR HOKESTEAD PURPOS ~
IF FOR THE PURPOSE OF ENROLLING. p~EASE CHECKS _
CIItt,DREN- IN SCHOOt.~ -PLEASE STATE }
THEIR MAMESS
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- - _ - - l9t8 SAP 24 J~ ~ SS
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. ~ EO AND FCCUR[tE0
CGUfIi Y. FL A.
p01TRAS
aERR CIRgJIT COU ~ - -
- REZ;ORO VEItiFIrG _
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I FUR1~-CEi~'Y that I w~ segister at m7 lo~l address when the regi~tsat~n boojcs reopen. ~a ooaiplr ~?itb all
otbe: regairemtnts d a legal residtaA. ai this Start. -
in
I FUR1~R CEItT'~"'Y the I hart na intcation to return to iozaser C amia'le.. and I i~otena tO Conat7, .
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Florian. perma~~a
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Swoes to asd sabs~ befare me this ~Y ~ - -
K~`OF''CIRGUIT COURT _ ~ _ - 1
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- BY: _
EPUTY t.ERK _ -
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