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,LUG 1 E ~oOUNTY. FLOR~ou~: ~ ,
~'TLis is ~ derlarstioa ei DomieDe sad
t5titeaship is the State at I~7orida that I am ~i this dq iasooosdaooe. a>Ad i>.
. _ cozda:a3t~ will Sed3m ?22.17. a Statutes. _ -
' • I was firmer ? akKall se:ideati a[ ~ • ~ sad I l .
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resided at - owener. I Lsw e>saojed m, domic7e to
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. a~ sum asd bare bees a bona Bide resident eltbe Stste oI Florida siaoe ~ '7 ~ da, d
1!_GZ.. and I reside at ~ •
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° - ST. LUGIE
Caanti.l:7orida.
ana this statement is to be taken as mT dcdaratioa of dtiiensbip. adn:l legal raidenoe and domic~e in the State nt Florida. ~
1 f fOR THE PURPOSE Of ENROLL, 1 NG - I f FOR HOMESTEAD PUR POSES
CHILDREN IN SCHOOLr-PLEASE STATE -PLEASE CHECKS
THEIR NAMESS
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• - 1979 SEP 24 A~ ii~ 52
• _ - F EO AHD hECUitUED
' tT~11C1E COW{TY.fIA.
_ R06ER PDlTRAS - - -
- CLfR!(CIRCUR'CO ~~T~ ~~C~~.,, - -
' - R~ORD 1'ERIFiEO.._.~ ~~r~w_~! -
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• 40093.
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- I F'UA1~R'~'Y that I w~ register st rap loch sddrzss when the registration boobs reopen. sad eomplT with aII -
other segnisemeats d a legal reside, d this Stste.
I F[JILT~R (~iTl7'7C that I -hart ao intention to rtturn to mT ioranr doandk. sad I intend to remain in
_ _ _ T . U C 1 E - _ ComatJ~
Florida. Permaaeadi
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c~E CCUN7Y • E~ ~
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Ty.eests a'a mbs~bedbetoie ~ tbn - a,J d ~ ~ .
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K~"C1RClJIT GOIRT
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ST. LUGiE GOlA~1TY,T'FL~R~DM ~ .
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