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~D~i~~~ti~n .t~f Do~ni+~ile end Cititer~ship
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TO THE t:I.ERK 4F TA>s CIRCtRT~00URT. .
ST! t_UE I E OOtINi'Y. FLORIDA:
R1Js is vV deci.ratio. at D~idte and CitbenshiP ~ the stag d Fbeida t~ I am tltia ~ i. aaamdaaoe. and in
aiotoemitF with 8eetioe 81.17. Florida 8tatutee• -
. I was f a lepi reaide~t d ~ .9 UA ^/A _ ~ L L ~ ~ S and I
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resided at b . a 9 ~o ~ T 1l ~ T.q T E ST I~ E . ~~a9rr, I laN Cbao~d ~ aooridl. to .
- lafnst ea~?lawieel - -
and am and bsve besa s boew lido raidsot d Ihe,State d Florida sins ~ - _ d T
y dp d
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~9~aadIraideat X90 ~r9.9~s~A ~~P~t~~ - -
tlkewtdi~tolref
/~o~ r Y'! ER ~ t - - - ST. LUG 1 E coam~. Floeids, .
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and this statement is to be token as aq dsdaratios d dSimmhip. aetnai leKai saaidea~ee and domieili. i~ tba State d Florida.
IF FOR THE PURPOSE OF_ EMROtt.iNQ _ IF FOR NONE3TEA0 PURPOSES,
CN 1 t.DREN 1 N sCNOOt.e_ PEASE sTATE PLEAlE CNECKS `
THE1R NAMESt -
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- F p AliOpi+E~T!f~ ~
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- 1!'ERIFift7 _ ~ -
- - - ~ ~ - 4'79
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I F[TR'1'1TEK CERTII+'Y that I wiH at ~ ba_
1 ad~irao when the reEhR~ioo boats eeopas, and eompl,~ with a8
other regaato d s leKal raddsat d tltb State. - -
1 FIJATAER CERTIFY that I have m iotentioa t_
o_ retara to farmer aed I iate~d to ~ in
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Fbrida, permanentl; • ~ - - -
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~ s,'' _ \oe S9o / - Cr9 3 S ~ Y~ P~ ! %FiPt'~ , ~~o t'ip,~
8aaen to and snb-`~ arms this °t S` ~ d IA~1
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E R(3f~ER POI TitAS, -CLERK OF G:RCUi T CO~ItT -
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ST. lUG I ~ COt~NTY, fLOR 1 OJ1 -
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BY: o . - - - ~
• EPUTY . LERK ~
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• ACA Form 71-2t