HomeMy WebLinkAbout0167~,'
~~ 1 219
' ®eclorotion - a~~~om~ile an~Citisonship
TO'THE STATE ANii COUNTY TAZ AO$, -
a~____.uto i~ COUNTY. FIA]it1~A:
This fs nUr declaration of Domicils snd (whip in the Stets of P'forWa that I sm llling this day in
accordance, and in conformity with Chapter 222, Sectic+n 222.17, Florida Statutes,
I was loemerli- s legal r+eiident os _Cleerfiel~ __~__ ,~, P~,a~i~eniw _...
- t~-) (San)
s~.~ r ,.~•-~ sc _ 3vg_T~~+~.1$~- a'~S~~t~___-_-.- - -- _ - . Ilowever_ I have chana~ed mr domicile
__~ _ :~__-_ -- (Strwt and Nua~b~) - - _ -- -
to and am and have been a boas Bde resident o! the State of Florida aince__-__..ls______________----_--_--day ad
----D~oewber _-- __-_~. 19._._~Q and I reside at io~_ s_ ~~LseL
i+~w~ atlo ~ieso~i ~------
!'ort • Piro a 8`i;_~ Luc ~ • _____ ~_County, Florida,
ccxb)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
i rn~..r ao~deil~i. rra~ ~ to n ~domid~voreba.s cd ~ia~oi.Ds~at as a~vblm~at at
I11/)I~, iMp drA YV~VYYiV Vii
V ~~ •
F,~ ~ , ~ ~,~, Fr ^ ,
,_~ ,• ,.
I" ~{
.-..
- .: ~~
I FURTHER CERTIFY that I will register at ~- local address when the registration hooka reopen,
and Damply with aU other requireale~nta of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former doaucile, and I intend to remain
• Fort Pierce 3t ,~A____~r._________~_Coanty, PYo,rida,
(cjts>
permanently. __-~~ ~ - ____..~~-~_~_~
J (N ... .
HdrveT A. Yorgsn _ ~ .~_:..;_t= :~•?,w.
Sworn to and subscribed before me this--•__-~ ---day of ~ •;;'~~.~ .
RogerPoitras jClerk of Ciran~t Conrt ~ _... ~ %•~•-:~" ~~. ,: ,'
~~~~
iTo b. eu.eoaa fil a,>puaa and oar~blal lfbd wM.lt Clap ~+eoit Cootl, sad aopltcaa ~tl T~z ~s.a.or)
Bowen auDDll C~., Plant Cltl, 11n.