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'!00 THE CLERK OF THE CIIICUIT OOURT. '
S~. LUG 1 E OoUNrY. FiARIDA: .
;;'This is mlr daeLratioa a[ Damiole and t~snship is the State d k~orida that I am leg this dq k aaoa+danos. and b
eoaformit~ witb Sedioa 2?2.1T. Florida Statutes. -
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Gcc~• ~3~r~N ~ ~ - _ j'}'1, i~ anal
' I was i~rl a legal resident d
ICtq) . (Rise!
rnided at ~~.(~N-~~ 1L~ c w R N : ~ /h 1) ~ 1 yG ! _ Aowever. I hrre ehansed mT domie~e to j
ISe:~ec ad Nmberl '
and am and have been a bona Sde resident attbe State d Florida since Su ?3..-, e. ~P d t' daT d
19 - and I reside at yd~G ~ ~ H"
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- Itla+etadliml~rl
roQ P..r`C Kt a F-L _ ST. LUG 1 E CaratF,l:7orida„ -
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and this statement is to be taken as m7 declaration of eitisenehip, actual legal rssidenoe and domiale in the State d F7o~rida.
I F fOR THE PURPOSE Of ENROLL t'NG i f FOR HOMESTEAD PURPOSES,
CHttDREN IN SCHOOL,•Pt.EASE STATE PLEASE CHECKL
THEIR NAMES:
s ! FILEO AN: ~•~Ep `
- ST.IUCIf F14.
Rt:.~ .S
CIEe~ ;
REC4: ~ ; . i ~
DEC I9 IZ 49 7~
. - 4'70037 ~
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I FURTHER ~'Y that I w~ register at m~ locsl addresr when the registration books reopes. and eompl~ with aU
other regniremenb of a kgat resided d this State.
~ I FURTHER CERTIFY that I have no iatent~oa to return to m~ former domia'le. and I intend to remain in
` ~ T U C I E CountT. ~
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Florida. permaaenu;_ ~ .
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~ (Name)
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Sworn Lo and sabstnbed before me this ~ daf d l' d P ~ e. ~C L ~ t 6 ~
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ROGER FOI'iRAS. GLERK OF CIRCUIT COll~2T , -
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ST. LUG 1 E GOUN7Y,- f LOR 1 OA
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z E PUTY IERK