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ther (please describe): Date of boons: OS of Arent 11/1812018 11/12/2018 I V'siting from another stale and establishing a temporary residence In Ftonda. Current Permanent Address Future Permanent Address 8100 Red Hook Quarters Ste 83 bears Una 1) IS St James Islands (Address line i) warms Line
Florida Statutes} Month of Birth Jan Feb Mar April May June I must reregister In: Jan, April, July & Oct Feb, May, Aug, & Nov Mar, June, Sept & Dec April, July, Oct & Jan May, Aug, Nov & Feb June, Sept, Dec & Mar Month of Birth I must reregister In: July Jan, April, July & Oct Feb, May, Au
er v.:in:country' 0 Temporanly leaving Florida to visit another state/country E3 Moving from another stale to permanently establish a residence in Flonda 0 Visiting from another stale and esiaNishing a temporary address in Florida Other (please describe): Dan of Capstan: Dale of Naval: Current Per
y, Aug, Nov & Feb June, Sept, Dec & Mar Month of Birth I must reregister In: July Aug Jan, April, July & Oct Feb, May, Aug, & Nov Mar. June, Sept & Dec Sept Oct April, July, Oct & Jan May, Aug, Nov & Feb Nov Dec June. Sept, Dec & Mar 14. In addition to the registration months listed above, MUST
lm Beach Cottly Administrative Complex, Prim 'Mach County. Florida 33101 and the State of Florida. Honda Depanmeot of Financial Scnios. Tallahassee. Fonda 32399 an the following mw as Indic:tied: INITIAL MAU= 1. 2. 3. S___ S 5600 5. S 100 6. 7. S 2 00 8. S 20000 9. S 65 00 10. S 3
t reregister in the months of: Month of Birth I must reregister In the months of: Jan Jan, April, July & Oct Feb, May, Aug, & Nov Mar, June, Sept & Dec April, July, Oct & Jan May, Aug, Nov & Feb June, Sept, Doc & Mar Feb Mar April May June July Aug Sept Oct Jan, April, July & Oct Feb, May
lm Beach Cottly Administrative Complex, Prim 'Mach County. Florida 33101 and the State of Florida. Honda Depanmeot of Financial Scnios. Tallahassee. Fonda 32399 an the following mw as Indic:tied: INITIAL MAU= 1. 2. 3. S___ S 5600 5. S 100 6. 7. S 2 00 8. S 20000 9. S 65 00 10. S 3
t reregister in the months of: Month of Birth I must reregister In the months of: Jan Jan, April, July & Oct Feb, May, Aug, & Nov Mar, June, Sept & Dec April, July, Oct & Jan May, Aug, Nov & Feb June, Sept, Doc & Mar Feb Mar April May June July Aug Sept Oct Jan, April, July & Oct Feb, May
Entities connected to both Jane Fonda and Sept & Dec

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