HomeMy WebLinkAbout0977 ~ ~
~ec~~rat~~n Q; Da~-~~~ci~v C~~~ CII~~~~J~~~p
~ro Ti~t: STn'fi. ~~n c~ovh~rY 7~n~ nssi ssoiz. 258'796
` ST. II.UCIE T-- ~•OUN'1'Y, t= LOR11)A: '
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'17~ix is my d~rla~ation ot Uomicilr and Citiz.•nship in ihc• Statr c~f 1~lorida that i an~ filinr this ~lay in ~
t
accorcla~za-, and i~~ co~ili~rntity with Scrtion '_'2.17, 1=1orid:i St;~tutcs. ~
! was fornicrly a lcg::l rrsidrnt oi' _ _ and ~
J (City) (s~at
msidcd at . However, 1 have changed my domicile to
(Strcet aod Numbtr)
and am and havc bccn a bona tidc rosidcnt of thc State of Ftorida since - day of
_ , 19~y and 1 residc at _ ~ ~
(St~eet and Numbe~) '
Lucie ~
~~~~X _ , St . County, Florida,
(citr)
and this statement is to be taken as my declaration of citizensl~ip, actual legai residence and domicile in the State
ot Florida.
(Inseri here any pcrlinrnt facts, such u salr of property or business, or refinquishment of emptoyment at former
domicile, ~emoval ot family to ntw domicilr, purchax of Aome, rtc.)
.
~ • , ~~IC~.~.~t~tGU ~
258~ ~
. 96
=T~IUCIE COUNTr FLA.
ROGiR ~01TqAg
OtER!c C.?CUtt COURT ;
RiCORR VEf.IF1Ep."~,~,~ ~
~lut,13 il 13 PH'13 ~
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t I FURTHER CERTII=Y that I will register at my Iocal address wlien the registration books reopen, and ;
P comply with all other requireme;nts oT a le~al residcnt of this State.
E I FURTHER CERTIFY that i have no intention to rcturn to my forn~cr domicile, and 1 intcnd to rcmain in
f
; St. Lucie
~ . , - , County,
~ •f~q~ida~~it~rl~anc~tly. cc~~,~
4 ~ ; _ C ~
~r i S ~ , ~
F - :r: , ~ _ S~;r-~ C ~ 7 ~
, w'~'' Elsie Steinel (Name) ~ +
s = ~ . t
- ;
..=~.y; ~ - . _L_D;l ; : ;
t - • . Y : . ~Addres,) ~
: .....•GO G
t
` ~"':~woi~F to ~ s?ibscrihcd befor~ mc tiii; . ~ _ _ dat~ of •
- - - - - . n.u. 19 ~ '3 _
= R~GER POITRAS, CLERK OF CIRCUIT COURT
~
X~S:ifi~JC :.?.J.a,X04 ;r:?L,}:FiJCX
- - ~~~~_____Uenul.v (;lc•rk
- ~;?:~i~:~~;:t~ixitic:.~::~rKr:.:
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' ,Tu hr ciccalyd ~u Ju~,l~, etr ~n~t ..n. i~~ d 1JrJ ~:ifl~ t'1~•rA l'nci~it Cuurt.:u~~l dup6c.dr ~~~lh 1'rx A~~cstiut)
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~ ° R 216 PACE 97? '