HomeMy WebLinkAbout1723 ~~~~~~"t~cE~~ C~i ,~O e
tsC«~ ~~'e~ ~:i~t :~i ~tii~ ~
•ro •riu: s~r,~-ri~ nnn c~ou~~r~~ •r,~x nssi~:ssoit, '236209
.
~.s~c~--c~un•rY, i~LUitii~n:
11~is is my ilcclaration of Uc~mirilr :u~cl C'itirrnshi~i in thi: Stat~ of rlorida that 1 am Gling tl?is day in
accordan~r, ancl in conformily ~vilh Scction ~?'_'3.17, l~lorid,i Statut~s. `
I~vas fonncrly a I~ral resictcnt ot f , ~7'~l . and I
(ci r) (slatc)
residcJ at ~~/-lll> . Ho~vcvcr, I ha~~c changcd my domicilc to
(Slrer! and Numbrr)
and am and .have bccn a bana fidc n•sidcnt of thc State of rlorida since l~ day of
19_.2~.., and I residc at ~ /~3
.
n . (St~eet s~d Numbet) lj1P/YCeL
~D- , ~ ~/.t~~7 ~~a C` , ~yl
~ ~ Ct C~Qi ~ County, Florida,
tc~~r)
and this statement is to be taken as my declaration of
citizensliip, actual legal residence and domicile in the State
of Florida.
~
(insert htre any pertiocnt facls, such as sale of property eK- t?uciness, ot relinquishmeM ot employmtnt at fotme~
domicile, removal ot (amily to ne.v domicile. purchase ot home, rte.)
' //~~f ~ ~ "
o~~ ~~~rs.
' FILEO AN~ RECORDE~ ~
- ST. IUCIE COUNTY FLA. p~,
ROCER POtTRAS ~"e
• . CIERK ClRCUIT COURT
. RECOR~ VEFtf1ED
~ = Auc 15 2 s9 PH'71
~ ~~36209
;
•
~
~
I FURTHCR-CERTII=Y that [ n~ill rcgister at my local address when the ngistration books reopcn, and
comply with all otlier requirements of a Icg~l resident of this St~te.
I FURTIiER • RT1FY ttiat I I~a~e no intention to return to my tormer domicile, and I intend to remain in
.
_ ~ -e_°/h'~'~' a,i~ - .s~k C f !
, County, ~
Tlorida, pcrmancnUy: (c~~r~ Q~,~/ •
~r~
.,p•~~=«~.~~~i~,,~ ~ C- - /
~ • :3. ; ~ , . . /~`!~''"'~~'L~'~//' ~f~'~/'/c- ~ ~sC ~`c~° ~f
~ - , ~
~ • ' ~ (Name) -
, ! _ ~ /l..SC°~
~ _ _ S, c' c~ .
, . ~ . (AdJtess)
Sworn ta.and subscrihrd bcfor~ mc this day of
- . ~ • ;
A.U. 19 - ~
_ ' ~..y~ .s 1
str 1'u ir Strlt u( 1 lurida at r~:r
My Commicsion r~t~ihs - - 7~ ~ .
(Tu I?r c~rculyd io duplira~r anJ miKiiul fd~•J ailh l'Irrk ('ircuil ('ourl. anJ Juplw•alr wilh Taa MawK)
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