HomeMy WebLinkAbout2621 •
~ec~aration ~ of ~~nntc~le and Citizenship
ro~ca~Ilaor~cz~ocurroouar, ~ .
ST. lUC
1L.
E . OOVi~'r'r: !'troBIDAz ,
Tiia is aq dadaetioa d Do¦~ksa asd Cit~esiip b tia scat. d lsoeida fiat I as ta. dq is seooerlasa. ssd irl
w!'ti IEE.19. lloeida 8tat~s.
~ ~ -
' I was t a 1~pt n~NaR d U ~l~h~ 1~.1 . l~~
~ a~I
f (p41 ~l
~ ~d at ~212'J T ,t22i1 ~
~
~~1LF - Na~e+rae.I M~ eia~ad wr domidi~ to
and as aiod)taw b..a abooa m. r~aidaRdtM ~ dl~idaaisa ~ F~ / 9 8~
1! ~ aed I ewe aR ~t~,,,,~~~iEw/T?rJOd~
ST. LUG i ~,ar..w~ - _
ca ~ / 5 T d ~l ~ - Coin. !'loeld..
taari _
and ~ statemeal ~ to fakM M Op dodaratio~ d . setual 1Kal ~+eaidNlee asd domie0a ~ t1N StatA d I+focid4.
_ IF fOR THE 'URrOSE Of ENROLLIN4 if fOR NONESTEAO ~URrOSEfo
CNI~LOREN 1N sCNOOLa (LEASE sTATE tLEASE CHECK:
T Nt 1 R NANE i t j.._,_..,..1 -
~is?u7~iS/ J`d~l ~y E LL _
4'x'2
180 ff8 ! 9 PN t= 04
fJ~CNKUIT COURT
RECORD VERtflEO
I P'UATH>yR (~ElTIP7f fiat I wiR at nqr ioai addreao wigs tLa rapstrstios books :+sopas. aad oomph wlti sH
otb~r regnbs at s >oN saidrat d tii Stag.
I FURTAER t~ItTIl7t tiaE I ia~s m iotestioa to ratmn to faeaier . ~aod I int~ead to reo~ais_ia
tab)
Florjda. perma~;. .
auk
rye ~ Q
-
ti 0?!
tNeswi
y~~.p„
u+~..~r
swoon to and snb.esib.d b~ til. / 9 dq d ~Sr3 SLtJ ~i~a~co ~ D•P
.RIB POi ASS, CLERK OF CIRCUIT CO~tT ?udh'~i fi • Rr~/l
ST. IUGiE COUNTY, fLOR10A
8t?: -
'UTY LERK -
_ -
. - ~?~i5
B~~ .