HomeMy WebLinkAbout0252 ~ -
~G~v~~i G.~~i~~~ Q~ f.i01 <<?vt4~ C:..~ L~..1 ~i~~~.~• ~.~'~1 l.is
c~ ~r~ic srn~~i: nrt~ cou~.~~~• -rnx nssi~:s~oiz, 26S'791
St .l.ucie
___T_ ___C'OUN7~Y, t~l.OKtU~I:
Ti~is is my drelar;~tic>i~ ~f 1?on~irilc :~nd C'itiic~tshi~~ ii~ thc St:ilc of t~lori~ia thal 1 am filin~; thi~ ~lay ii~
a~•~•orclance, .~nd i~~ conforn~ity with Srction ~~,.17, t=lori~la Statutrs,
1 was formcrly a I~gal residrnt of _S~_~n ~ n ~ ,~E'~ _ and I
(C ) ~stacr ~
3a C~6ndc.c,~ ~Q ` ,
rrtiidcd at . Howcvcr, I ha~~c changcci my domicilc to
(Strcrt and Plumber)
aiid am and havc been a bona fide resid~ nt of ti~c St:~te of rlorida since day of
(~O(T~L , 19 73 and 1 /r~ idc :tt °~O°~ ~ . / Gz~n~!'C,?P~
~ ~ D . (Street and humbet)
p~CUC.~~°/ . St . Lucie _ County, Florida,
(c~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. -
(Insett hrre aoy pertinent facts, such as salr of property or business, or relinquishsnent of emplo~~~nent at former
domicile, removal of family to ne~v domicitr, purchase of home. ~trJ
Entering children in school: ~
~ ~ ~ - - i;
Z~~c~~`c~ .
FICED 4 ~ '1
ST.R~~lE
~tfF. ~fT ''ORR#S~I'4'
ac~~a k ~~r~ "U17
v: c~~~,~~ r.Q(j#t? ..~j~
Act 1~ ~ P~ ~ -
T3
_ 26~,92
~
' ~ t
~
~ ~
~ I FURTHER CERTlFY t}~at I~vill register at my local address when the registration books reopen, and
cornply with all other requirements of a leaal rrsident of tl~is State.
I FU THER CERTIFY that 1 l~ave no intention to rcturn to my forn~er domicite, and I i~itend to remain in
~ ~D'~;t ~ f, uCc. ~ S~ . Lucie
~ ~ ~ , County,
~ Tlorida, permancntly. (c''r) _ ( Edwa..1 h~a+anews) ;
- - - ~
i '
~ (Name)
~ - aoa g w l~c~n 1~~ ~b~f ~~.~ic.~ -
,
. . " (Address)
Sworir'td apd'sutf
'L~ bcforc mc this ~ day of
. ~ . .
; ~ ~ w~ - ::t ='~N ~ ; T.-
: . • , a. n. ~ ?
3 . -
~ ~ ~t06~R POY~~-,~ CLERK CIRCUIT COURT , -
3 ~ . , j . . S,. + ~ " ,
3 ' ;•tiU~'~`~.t'~ r~~ .
_ - - .~...n„y,~j~Jt+~.rt..h"~""~w...
- - . _ .13}~.- •
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(Tu be execulrJ in Jupli.•r~c auJ urigu~al 111rJ ~~ilh 1'Ir~1. ('itauil Cnurl. anJ dup6i~te ~~ith "Ia~ Assr~.,~t) -
e00r,~iGV PA~E ~J~ ~