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Dec~ar~~~on of Do~~~~l~ and ~lt~~+~nsh~p
_ ~~~551
TO THE CLERH of T8B QR~CIJiT 00UAT.
ST. LUC 1 E OOUNTY. FLORIDA:
This is aqT dee4ratios d Daheidle and t~aenshlp Is the l;tste d l9orkla that I am IDinR this dyr la seooedaaa. aad b
eoaforatigr wsi Ssdioa 8$1.17. Flodda 8tstttlet.~
I aas t o kpl resident d L~ ~r?W wdI -
resided at - ~ tel. ~ s. 7 (cwl
tea.a.w r~..e.l - 8oari?.e. I tis.. dlaerd ~ domidM to
aad ant and hew been a boas fide;eaideeR dthe ~ oi>!'lorWa sines ~ ~ -r dy d -
~51 V ~ r i!~„ aad I sesids st S,LL ,V . -Ll.,t~-~" t `f~-$ tiL . ~ _
.~ct1,.~:i P _ ST, lUG I E . Florida.
ia~
- and this statement Is to be taken ae nUr deeiaratioa d eit;seaship. setud ieKai reddeaa and damirlie i~ tht Htate d Fbcida.
IF FOR THE hURPOSE OF ENROLLING IF FOR NOMESTEAO PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK!
THEIR NANES!
I~fE620 ~1~21
S~~ RE TC~E_0
CLERK CMCtRT COfAtT
REC4lt! VERIfi[D....
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i~l~'SS~.
I FURTHER CERTII~'Y the; I will at ~ loeal address wbea the ra8istsatioa booiu reopen. Gad eompy wiN~ afl
other rega4emeate d a lesal reaide~ at this 8tat~.
I FURTHER CERTIFY tba! I haw ao iateation to ratllrn to_mT fawn damidis. and I intend to remain in
ICib) -
I~7orida, permaaeatl;. .
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tl
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sworn to and sabeeribed betae+s me this dq d ( 3O se t0 - Wl ~ 1.l- ~ 121
R~ER POITRAS. CLERK OF C1RCU1 T COtl~2T
ST, lUG 1 E COIHVTY, FLOR i UA
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8Ys -
EPYTY LERK '
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