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'FO TAE Q.ERR OF 1'HE CIIiCUIT OOUR't. • '
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This is m7 dee]aration o[ DanieAe cad (~eaship is the State of 1E'lorida that I am ~i this dq la saooedaaos. aid is
oonfarmitT with Seetioiv 222.17. >r7arida S4tutea. ~ .
I was formed a jegal resident o[ ~y~~~.tw z•- - ~ cad I
lCk~l . Is
resided at g ~ - However. I haw ehsaged eqT domiole to ,
It3tr.d aed Hombal .
and car and love been a bona fide resident os the State of Florida since ~ ~ _ ] 9 7 ~ _ _ daF d
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19 - and I reside at ~ o --~L-~
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y,L~¢, ~ ST. lUG i E Connti.l!7orida. ~
and this statement is to be taken as mT dee]aration od eitiunship. actual kcal residence and domia~e is the State ai Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL,-PL.EASE STATE PLEASE CHECKS
THEIR NAMES.
s t t.EO An!- ~,;.-CEO
LUCRE ~ FIA.
RCS:- -S
CIEs ~ , - . . ° i•0;1R
RECOkt~ - ~ - ~ r~
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I FtJR1'fIF.B CERTIFY that I win register at m~ local address when the registration books reopen. and eomplT with all
other regnirements a[ a legal resided a[ this State.
I FURTI~R CERTg'Y that I have no intention to return to mT former domic~e. and I intend to remain in
T. U C I E , Count.
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Florida, permanend;.
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foremethis ds~ of ~d ~c•~ ~A ~ o ~~-~i0~.~~ ~.`~S l~ ~
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R ER POIIRAS. CLERK OF C 1RCU 1 T GOl~2T ~ ~I~N ~e f
ST. LUGS E COUNTY, FLOR 1 OA -
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