HomeMy WebLinkAbout2653 (3ecla~ a~~a~ a~ Qor~ ~~~~i ~~~i~~.~~~i -
2s6399
~ c> ~ri i~: s•rA•rt: nn~u cov~~~v z•nx nss~~.ss~~z,
St .Lucie
_ CUUN~'Y, l~LOltl!)A:
This is n~y drelaratiun of Uamicilc and Citir.cnship in thc Statc of I~lorida that 1 ant filing this ~t:~y i~i ~
accorda~~ce, and in confonnity ~vith Scrtion ~~'.17, Fivrida StaU~trs. i
- 1 ~ ~ . 1
1 was forn~ crly a lcgal residcnt of ~~'uL,~-~'~4-~L~ , ~~LV' '7~~ and 1
_ ~ (ci~r) (stalc) v
r~•.idrd at (Q U~1J ~-'`tY Howcvcr, l havc changed my do~nicilc to
- ($treet and Number)
and am and have becn a bona fide resident oC ll~e St.~tc of Florida since day ot'
, 19~.~, and 1 /r~ d~ at ~ v_~~' ~
f~ _ (Street and Numbet)
- St. Lucie County, I'lorida,
~ (CitY~ ' -
and this statement is to be taken as my declaration of citiienship, actual legal residence and domicile in the Siate
of Florida. -
(lnurt here any pe~line~t facts, sucl~ as sate of pro~+erty or businrss, or ~eli~quishment of employment st formet
domicile. rrmoral of family to ne~v domicile, pu~~hase ot hume, rtc.)
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~ - 266399 ~
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~ filf~ aMi !tECORDEO '
:T.11{C~E COU~?Y fLA. t
• " RaGEF FO~TAA~
CtERR ti=:CU1i COURT
REC~RA v~~.lF~ED
Oct !8 1 3a PH'73
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1 FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
comply ~vith all other requirements of a legal resident of this State.
' I FURTHER CERTII=Y that I have no intention to return to my formcrdomicile, and I intend to rcmain in
~ .
' t . . - r , S* . L.ucie '
' ZL 't-`~= CauntY,
t~lorida, permanently. ~C''Y~ ~ . . ~
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. ~ 4 ~'Wti L'l-~%~+~'l'
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~~4~2LG5 F (t~ame) T' elSe/~ E
- c~ ~ ~ ~ 1 'i,?~-~'~r~ •
~ (Address) ~ ~
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Sworn tcG~`~l31d sUb,s~~8~~cforc me this ~ d;iy of
~ A.D.19-73
' 9 : - . • .
Rt7GE _,Wt~ITItA~'~ CiERK CIRCUIT COURT ,
~ ~ T Y., :~'~i • ~ 1,
. - - ; v 0 RY ~~9 PA6E (rUS~
~ r•~ ` .\jO~ a~i - - ~OQf1
~ ~ beput~
y ~).er
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(Tu be ezccutrJ in Juptic-rrr a~~J uriEa~+.d tJrd with ('Irik Circu)1 ('nurl, and 1III~/I1i:11! K'11I1 Ta? Asic~wr)
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