HomeMy WebLinkAbout2933 ~~~lE~~•s~Gf~iu~ ~j C~.. V~ ~ 4~~tcv G~~ 4.y1i.~i`..L:i
i~ L:i~ ~
~349~5 1
~rc~'rt~i: s~r,~'ri_ ,~~n c'ou~'t~~' 'r~~x n~si:s~ur,
- - - - - - - ('UUI~~i'Y, i~ l_UI:II):1:
'fhis is nzy clrcl:~raliun ol' Uumirilr .uul Citir: i~,hi~~ in thr St;~t: ol~ [~lc~ricla that I am filin,; this d:~y iii
accord:~nrr, :~iul in conli~rntity ~~•ith Se~tio~~ „'.17, Florida St:~tulrs.
.
1~vas fvruirrly a I~,.:al nsi~l~nt of ~~~rt' ~.~L=~ _ , and I
` (CiIY) (S le)
resi~irJ at ~1~_l~''
''~7 ~~~~,L-,~o7 ~L- l lowcvcr, 1 havc chang~d my do:nicile to
(Sirr~l and I~u~ntK•r)
and am and ha~~c bccn a hana fidr r~sicl~nt of thc Statc of l~lorida since day of fi
~ ~cc.~~ _ , 191~ and ! msidc at /.S L~
i (Strrrt and Numbe~)
. .
~ . County, rlorida,
(c~~> )
and this sthtemrnt is to be taken as my declaratian of citizenship, actual kgal residence and domicile in the State
of rlorida. ~
(Insrri herc any ~rttincnt tacts, soch as sale of properly or buciness, ot relinquishmcnt of employment at formet
domicile, rrmota) o! faniily to nc~v du~nicile, purchase of homt, rlc.)
~ ~32~'~~1~ i ~ ~~Gtie~~tX~-? ~l/ti~ '
- - ~I/
~34915
FILED ANO RECpRDEp
ST. ~UCIE COUMT1f fU.
ROCEit POfTRAS
CLERK CIRCUIT COURT _
'RECORD YERIFIEO~~
I~ 1 2 2s PN'71 ~ ~
~ .~z'~`'`~
i
- - ?
i
,
1
~ . '
f ,
~
S
i
~ I FURTlII:R CE}tTIPY tlr~t 1~~~ill register at my local address whrn ihe registration books rcopen, and :
~ comply with ali othrr requirements of a le~al resident of this St~te. ;
i
I rURTIiE:R CERTIF'Y that 1 ha~•e no intention to rcturn to my former domicjle, and 1 intend to remain in ~
~ ~
~ _ ~r.Z.` _ = c~~r.t~~~ , , County,
~ F~luti~a; ~~i~r~tt~ncntly: cc~~y~ _ ^
~ .~C,: '
~ ~ • " • `
~ ' _ ~ . f ~ • (Name) ~ {
~ . _ . , . ~
, . ~ S~ • ` t
~ ' ~~t- :
~ 'i` i ~ (Add~css) ~ _ ` , ~ ~
~ . - . . . . . . . . ' _ : ~.rrc_n_l~ ;
~ S~yotiit ~~t$suUscribrd h~for~ mr thi. day of
~ . • -
~ ~ l A.U. I
~ _
: ~
~
~ alary 1'uMl~~• Slet u 1 I•.nJr ~I I at_.. - - l
~ ' -~7~ ~
1~1~~ Commi~.~ion rx~~irc: ----`_L~`--`"-_'~---
~ ; , ~
~ (Tu Irr r~eculeJ ~n Jnph.a~r aud.~nl•~n~l hlrJ ~~i1h l'Ir~l ('ircuil C'ourl. anJ duplw~alr a•ilh "fas Atcccu?r) ~
~ a~zo4 ~zs3z ~
. ~ ~ ~ {
~._x~~~s_-~.~~. _ _ _ . .