HomeMy WebLinkAbout0387 - ~ - _ ~ , . - _ . - - - - eea~
' ' • ~ tie end -ir~ti~~~~hi~ . ~`F
~~cia~ation of ®c~i~ ,
-
- ~'7~6i
-
- -
- ~rolssc~olrr»'couRT. _ -
ST Ll!'C 1 E ~OVNTYr s+~.+~••-~ - - ~
Tb~ is ms ~ of Domiega ead is tle~ Stst+e d Fbeidr- fiat Y. am ~tiass tfd~ d4 iA °0~ !°d ie<
wiW 8~osio~ ~7. I+hoekis &at~'- r---- • -
- I was to e~ lsgalss~sidesot d . lCb) 3 $ y ~ ~ tetnw .
M - ~~s~I~t~1 ~~PC `r~~.~ -~°i
and tae ant baw beeo s boot Bde raaidtat a[ ibs 8tat~ at>:'ioeids sises
, ~ - __1~?q .asdI:widast _ e ~N~O. ' - -
: ~ - ST. LUG 1 E _ `t7ooa't~ Fsod~-
tclvt - -
d eit~i~ambip. acteeat ~ ~c i° t'b`+''-at Flarids-
ind tLis statamant b to be taiuaa as ssF dedt~rati~on r ' ~ , ! t ~
IF FOR NONESTEAD PURPOSES
_ 1F FOR THE PURPOSE OF ENROI.~lN6 PLEASE CHECK:
CHILDREN IN SCI:DOLa PLEASE STATE
-THE tR`-NAMES: , _ _
_.Z -
RJ
- ~ - - CIEF'• ~wiT CCtl~T -
- _
-
. - - - . - 4'73~~- - •
- -
~ - - - -
i g~EB CERTFFY tbac i will ' at m~ local add:+ear ~?Jesa tbs ° boa><s aenl ~
nq~eats d s legal resident at tbis Stag. _
I FURTHER ~TIb'Y that I have ~ iatention to return to fuctear domia7e. uod I intend to
i - _ -
I - cats) - - _ -
F{arida, permanend;. -
-
~ COUkl` -
~ ~
a °f V
~FCJUl~T~.F~
SAOTfI t0 tali sgbecribed bdareme this "~j ~ -
i
• o- . -
ROG P01 AS CLERK Qf ~ IRCUI T ~Ot~RT-
~
S1'. LUG 1 E _ C~}UNTY, f laR 1 QA - - ~ .
{ " -
_ EPUTY t.ERK _
P~