HomeMy WebLinkAbout1669 ~.-,~.LS::i:.a':i~l'] G~ :..:i.ii:~',::i aZ.~:~ ~:2~l~~:.'1:~4~:i~
~ J 7Nc STATE A\D `O.:\ ~ Y i AX A~~~~.~v~. ' ~
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Trus +s n~y ~f~~,a~aron ot Do: :~.iie and Cit~zi:r;s'r.~~ in ;he S~.;te of F:o:ida that i om f~l~ng th;s cay ~n accordance and
;n con{orm;;y w~th Lhap!er 222, ~~cr;on 222.i7, Florida S:atutes.
I was formarly a :eyal rasident of ~f0-~~~,J_lt - . _ - - '~~L~~~c'~~ -
(Cisy) (State)
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c,nd I r~sided at _--.~C;,__~,_ v_E,1%~:.s-_~ _ W%.!(~~~"'!~7~1_A«•'__ However I have ct-~s~~ycd my domi~ile
(St~eet and Numbzr)
:v arid am and have ~ean a bona fidz resident of the State or Florida since day of
' ~_~'t/ , 19~_S, an~ 1 reside at - _ -
(Street and Numoer)
F~RT PlERCE, SAITIT IUCIE COUNTY~ FLORIDA
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~ and this statement is to be taken as my declaration of citizenship, actuai legai residence and domicile in ihe State of Florida.
> (Insert ~e:e any pertinz~; facts, such as saie or property or busi~ess, or relinquishment of employment ;
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at former dom~ci~e, removal of family to new domicile, purchase of home, etc.) ~
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= 1 FURTHER CERTIFY ihat 1 wifl comply with all ot}-,er requirements of a legal resident of this State.
t FURTtiER CERTiFY that I have no inte~tion to ref~m to my former domiGle, and I iniend to remain in FORT
_ ~~cRCE, SA1tiT LUC:E COJN'+Y, FLORIDA, permane y. ~'~Q/yEST f. ~~f.Ji f~' ~~'r
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I ~E4 AND aEC0110E0 -
S~. 4UC~E COUNTY flA. C t+~.. ~
IIOCCR PORAAS i ame) ~
= CIERK C~hCU1T COURT ~
~ RECORD vER~F~EO Kn,'RjSN,7y~lr8 ;
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Ocz21 ~~~16 t~ sa~~-~~_vr~,~~:.~r 5%. ~
_ (Adaress) {
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- _ 21'7600 ~ ~
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- Swcrn tc ar,,; s:.~scr~bed beiore me th~s day of ~ , 19~.
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C Notary Pub~ic
. . 1J1y Commission exp~res _-1~~~~~~ -
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(To ba exawfod aa drp~ie+ie ar+d oriQiirs}-filcd witi~ Cierir~ir~trtt~8vrt, ~n~-d )
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