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HomeMy WebLinkAbout2672 ~~~...v'J-:~.1r~'.a?~.~.r~i~~~IF:w~v~. '~~.?~v> . rr. w r ' ..J ~.r. +~r _ - - ~ _ -r~.^~-..r_-T.. . ~ • ~ ~ ~ D~claration o1 Oornlcll~ ~r~d Cl+tizinship i ~ 135~5?7 to n~ sr~~ ~wo cau~rr T~x ~ssESSa~, s~. wa~ c~ouHrv, aat~o~?: Thh h my d~ciWNbn of Domkii~ a~d Citi~n~hip M th~ St~h df Florida that I~en filirp N~is d~y in roaorelM~a a~w! ~ M aonfwmily with CMplK Z?!, Ssction 442.17, Florida St~hil~s. ~ . I wa* iorr~rly a Ipa! r~fd~t af N~~t Cit~.. Ktr YOS1t ~ KiHI l~'~~ • t ` atid 1 nsid.d •t s0~._Broad~?s~ - How.wr ~ h.w ch.np.d my don+idM ~ (5t~t ad Numbsr) . ~ ~ b ind am and haw be~n • bona fid~ r~sWsnt of the Sta1~ of Florida tfno~ dhr oi i ti~r ,~q~, .nd i~id. ar 121 Beaeb Ase. Ri~rer P*rr ; ; (str..t ~r?d IVumb~r) ~ 3 Y ~ ' ~ ~ ~ ~ ~ • ~n . ~ ~d tl~is dat~n~nt i: ta b~ taken a: my declar~tia~ of c~tiz~uhip, actual Ipal rtsld~r~c~? a~d dv~r?icil~ in th~ 5qt~ of Horids. A p~?~t h~r~ any partinsnt facli, such as sal~ of propeny ot budnsu, vr rellnquishmrnt af ~?ploym~nt ~ at formu domkflt, rerrwval of family ro r~ew domicile, purd?ss~ of h~rr~a, dc.) ; ~ ~ : ; ; Eatabiishing residenc~ , - _ a ~ ; ~ : t ~ a~~1~ ' ; ~ ~ ED ~ . ~ ~~°3oar~ ; . ,,,,~u~u~„<<~ . ` ' .~``v~Ts~~C ~ c~ ..........o~'~f, Y 6 pM12:55 ` ~ ' ~ ' ~ • 1965 Ma " „ ~ ~ ~ . 4 ~ t'' '~--4~ z'~ = (~~~K ' ' ~ ` ~ wb~~•. ; ~~;.a Rp~E~ ~ IT f•~~~10~ ~ _ « : , ~n ; : ~ ~~i~ • ~ - ; g ~ h : = . e . ~*r~ • ~ ! • .A`~ ~ • . ~r•-,. . 4~, • , ; ~ fr, ~h •...~9?y",•\~t. . t •y~.~•.. 'i' 0•'~1 ~ • ~~~~~t ~ ~ ,~~~1 I,/!!11{11111~~ . . r. ~ . 1 FURTH~R C'EitTiFlf thit 1 wil! oomply wNh all oth~r nqui~h of s tp~ ~uldrnt o~ #~i~ Stat~. ' 1 FURTMER CERTIFY that 1 have no intention to retum to my former domf~il~, and 1 lnta~d tc rrnale~ ir~ FORT Pt~~,~1~T LUCIE COUN~Yf PLORIDA, permanenNy. ; . . , ~ ~ v~~ • ; C t .........,0 '~ir • ~ ~a~ • ~ J~` ~ °i ? i ~ ~ i `+~'G~':~' r ~ ~ • 1 t (trame) ' ' C ~ ilI ~ , : ~ . ;~f.;~ `n : ? ° ~ ~1;. M ~ • ~ S~ F ~ ~ .~~~'.1...4u~~ ;~~~~-a,, . : • ~ : . 'k''ti -~r, ~i ~ ~ . : : .f . ~r , _ r!.~• '•.~'•Y ; M~idred Q~/lsf~ ; ~ II~ j,~ „'~?,4~~~ ` i i ' ` S~worn to and wbarlbsd b~fars rrM thia itb d~y ~f ~'7 , 14 bs. ~ 4 ~ , $ PORRA: ~ ~ C~NT ' Notary Public + Cd o~e,.~•~r br D t. My CawMNior+ ~xpi~ ~ lTs iw ao~~M~i i~ wi~io~~l f~t wilh C~Irek CMwM L~wef, a~~l ~pNcM~ wlw Taut AM~~.~ $ - ~~7 2?i ~~~.,.V.~..~ _ _