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5158pS
~ATE OF FLORIDA )
ST. LUCIE COUNTY )
Before the undersigned authority personally appeared LEWIS
CLAY DILL who by me being first duly sworn, upon oath says:
that my name is Lewis Clay Dill; that Affiant is the natural
father of the minor child, VIRGINIA ANN DILL; that Affiant has
had full custody and control of the minor child, Virginia Ann
Dill since six weeks after her birth on September 19, 1974 at the
Ft. Pierce Memorial Hospital, St. Lucie County, Florida; that the
natural mother of Virginia Ann Dill has never had custody or con-
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trol of said minor child, nor has she contributed to the minor
child's support or visited with or seen the minor child since her
birth; that the. residence and address or whereabouts of the natural
mother of Virginia Ann Dill are unknown to Affiant; that Affiant is.
placing the minor child, Virginia Ann Dill, in the custody of
JERRY LEE DUBBERLY, 213 Lucero Drive, PoXt St. Lucie, Florida;
that the said Jerry Lee Dubberly shall have all rights required to
see to the health, wellbeing, rearing and support of the minor child,
Virginia Ann Dill, while her custody is vested in or awarded to him
by Affiant.
Affiant sayething nothing further.
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ewis Clay D
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subscribed before me
~ of January, 1981.
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, State of F1 . at Large
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