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'1'A6 to ~qr dtelatat~ o<Doaikilo aad Qttir~ahip be tM Stab at FNrida tb~t.I ~ ~i tAb dyr M aotonlaooo, aMl iR .
Evnta~aitr aritA Sectio+~ 2~3.IT. Fkxide Stst .
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ST. LUG 1 E tla~ety. Florida.
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t ' iuid tbb ~?tement is b 6e takes as a~? dedse
atioa of dtizeashiP. setwl kEa! re:ideaea aed doaaic8e L4 the State of Flo~da. -
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Ir PeR-TNE PURPOSE OP ENROlLIN6 Ii.iOR HONESTEAp PURPOSES,.
6H1lOREN 1N SCHOOi.a hIEASE STATE PLEASE CNECK:
- THEIR NAMES.
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. I FUR1'ItF,R CERTIFY tha3I rRl regisbr at my beat address when the registratiioa boots reopca. aad eoaipty alth aA
other requiremcAts of s legal resident o[ this State. -
I FURTIiE;t CERTIH'Y thri I Nava ao iattation to retnra to my former doaoteik. and I intend to reauia is
' - ST. Lucte
tC+ttl .County.
Fbrida. permanen~t~ .
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Sworn to and su!•seribcd tretoro mo this 9 day of
GAR PO~TRAS. CLERK OF G IRGUi T COIXtY
_ ST. LUG I E COUNTY, F I.OR i UA - ~ -
BY: ~ FfB ! 9 P!1 Z~ S I .
PUTY ~LCRK
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