HomeMy WebLinkAbout0857 • t 1 • •
~G:~.lL'.~.iC~~. t~~~~ Q~ ~Qi c~~i.~ic:EV ~~n: ~v~L~r_,.~:.~i.r',~ i•',
rc~ ~~~~~c sTn~ri: ,~~?n c~uu;.~rY ~~nx ,~ss?~s~o~z, 26'7208
St.Lucie
- COUN~ Y, 1~ LOltll)A:
"17iis is my drel,~ratiun of nun~icilc anci Ci[iz~n.hi~~ in thc St:it~ c~f I~lori~t:t that I am fili~~~~ this ~I:~y in
accora.iiire, ancl in confurmity ~vith Scctia ~'2.17, Plori~ici StaUitcs.
I~vas formcrly a Icg:~l resid~nt of _ d G~1~~-S~'~ I~ ~e ~f d{~ l
, and 1
• tc;~r~ ~s~a~
r~;~drd at C~~ p . HoK~e~~er, 1 ha~e changed my domicile to ~
(Sircat aud Number)
cmcf am and ltave bcc~~ a bo~~a fide resiclent ot the St:itc of l~lorida since ~ 7 day of
, 19.~_, and 1 /rc ~c1e at E. ~v ~ f} /~~i
~ Sirect and Nun~bcrj
~l •
U C St. Lucie Co~mty, rlorida,
(CitY) ~ ~
.
and this stat~mrnt is to be taken as my deciaration of citizenship, aclual legat residence and domicile irt the State
of 1=lorida. •
(lnscrt here any p.rtinrot faUS, Such as saie uf ~ro ~rt ar b::si:rss, ~°'^•••••^0•° :r.-~ :~ent at forme~ '
E r~ -
domicile, remo~~ai of family to ne~v domicile, purchacr of home, rtc.) ~
~
!
~ ~
~
26'7208 ~ ~ °
~ FIIED t+K~ RECORDEO - 0
St. tUC1E COUMTY FLA-
ROC:'^ i 01T4AS
CIEEK u~~.~UIT C4t1RT ;
~
ar~l?~^ ir":'~If[~ '
. Ocz 2 oi PN'73 ;
ti:
~
,
- ;
- ~
~ ~
~ ~
I FURTHER CERTIFY that I~vill register at my loril address when the registration books reopen, and
; coJnply with ali other requiremcnts of a legal resident of tliis State.
~ i
~ I FURTHER CERTIFY that t 12ave no intention to return to my former domicile, and I intend to remain in
S~ . Lucie ;
, ~ i
I~lorida ' , County, ;
, permancntly. tc~cy) ,
;
.
. ~ L
~ (Nsme) ~'D M ~ 5 .9 2 f
- ~r9~?-~~~~~,~~~ti~ . 4
(Address) ~
~
9
Sworn to and s~s~cihcd bcforc rnc this day ot
l v'Jr,"
~ t
_ : ~ . _ ~ ~ f~ ~ A. n. 19__?
3 . _ , f
RL~('i~1C..g4LY's$~~ .CLERK CIRCUIT COURT , ;
: S~. - ~R~~/~ C i
' " ~ • ' ' ~ ' ~ ~ /
' . , r~; : ~ f~• ~ SJ~J!; 'J vQ;;! J~}
° :
, ,~,s,i. _ . .
~ ~y~, ~ " ~
-~y
~ - ~ ~,•i••.,~...~•''~c~ Deputy ~erk
F ~ r n . r
t ~ . ~ .
` ~(To be eaetufed in Juplii ale anJ urr~:~+s.el !~lrJ aeUe t7rrA Cin uit ['r.uN. and ~fupli~ alr ~~ill~ 'faa A~~r~wr) ~ ,
~ ~
• _ i