HomeMy WebLinkAbout1739 f.1`L.E~~ ~~C~~i~ ~~i ~d:~i~:~~ G:i
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-rc~ •riu: s•r,t~r~ri~ t~au~~l~i~ •rnx nssiss~it, ~ 236223
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71~is is my c:~~ci:ir:~tsc~n c:!' !)on~ic•ilr ancl t'itii~uship in titc Stat; of ~lorida thal 1 am filing this d:ry in
accorciancr, :md in ral~formity ~~~itl~ Scctic~i~ 23'. ! 7, fioricl.i Statutrs.
! was fornzcrly a ic~,~l resid~nt o-F ~-v~~- ~ c • .
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residcd :,c -~~nR s~l.::
N~~ n~ ~~_~N_h%~ o., Ho~vcver. I i~a~~c changcd my domicilc to
(Sirect at~d hun~br~ ,
and am and have !~n a 5~i~a fidc n•sic!cnt of ihc State of rtorida since day of
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- , l~ and 1 scs::lc ~Q ~ CaJ
~ . (St~eet and Number)
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_ . ;~~~~-~c.~A? . • ~ - County, I=lorida,
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and this statement is to be taken as my dcclaratiun of citizensliip, actual legal residence and domicile in the State
of Florida.
' lnseri here any periincnt fxts. sucA as saie nf ro
( p pert.r• cx Ausincss, ot relinquishment o( employment al formet
domicite, removal ut famity to n~~~ domicilc, pu~chau of i?ome, ctc.)
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FICED ANO RECOROEO .
• ST. L!lCIE C4UMTY f~A.
' . CLfRK C~;CUiT COtlRT C0~
~ RECL~o,~ YEF.IF~EC~~,,,~ U
. ~ . Auc 15 4 31 PH'~1
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I FURT}ICR CCRTIf=Y ttzat [~~•ill re~ister at my local address when the registration books rcopen, and
~ comply with all other reqeiirements oF a lcgai resident ~f this State.
1 FURT L•R CL•RTIF=Y tt~at I liae•c no intcntion to rct~urn to y formcr domicilc, and I intend to rcmain in ~
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e ~ J . ' , County, ?
~ F?onda, p~rm~~~cntiy: (c~~r) . ~
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~ S~voni tb',;iiid silbscrih?rd bcforc ~n;: t#~is day ot
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~ A.D. 19~~ ,
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Kobry 1 !ic $I~tr uf 1 l~~nda ot I.aixr ~ •
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My Commi~.~ion c±:~~ires~~~~ ' ~ _
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~ L'fu 4x ruculcJ in Jupli.•~tr and ~~~iyin~l fd.•J ~~i1h ('1.•tk Ci~cuN Coutt. anJ Juplw•a1r with Taa A~kwH)
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~ $~;x~05 ~~f 1~3.~9
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