The URL can be used to link to this page

Home My WebLink About0179 ~ ! ~ ~ .~t ~~~y~(?~r ..~t ~ ~j i`~. , r ~ ~ \ i'1 /t ~ r " qt ~ ~ ! ' .Z ~ ~ ~J7 ~ t x \ V \.r i..+ ~ ~ Y l L ~ 1 fi.i ~ ~ ~ ~l ! w ~ ~ 1 ~ tif..~./ ! ~ ~d i~i ~ ~ I i 1 "iO'l lll•. ~'I~A~I~I~. /1hU ('Ul~^~l l' ~1,1X ASSI SSOit, ' s'r. i.t~cT~. c•c~uh~~~• ~~~~~i~u:~: 29830"1 ~ 'fhis is m)~ drrlur:iti~,n uf I)c~micilr :in~l ('itir~•mhip it~ ih~ St;itc of l~lc,rid;i tlial I.+.m filin~; this ct:i)~ iii ;~c~ur~laiicr, ::n~l ii~ rc»ili~rmit~~ ~~~ith Srrti~~n „'.1 "1. Fluricla Statutrti. ~ % : I ~+~:?s Ionncrl~~ a I~•~r:il resi~lcnt of ~h~ ~~-~-~~~t'R!N _ _ - - - - , ~'~ll_ and 1 . (CitY) (~telc) 1 r.•si~lr~l : t . _ ~.~7 t c'~:'` -~R[Y~- - . - . llo~t~c~~cr, I tavc chan~ed tny domicilc. to ~ (St~r~•1 anJ i~u~nl~cr) ~p~, and .+m and ha~•r b~rn a hc~+ri fi~lr rrsid.•nt ot~ ihr . Statc of l~lorid.? sincc .r'~!~~~_- day ~I~ _~l.N:Nt,.. 1~l and 1 nsidc at 7C~ ~~i~_1--~i~1S~_~5---~L------- ~ - • (Slrect anJ i~tumtxr) ' ~ St . I.ucie-,--- - County. l~lori~la, ' ~a,~~~-_ _r _ . ~c~~~~~ :,n~l thic statrmrnt is t~~ hc takrn as m)• dccl:u.~tion of riti~rnship, actual Ir~.il resicl~nce and domirilc in th~ Statc uf I~lorida. (Intirrl l~rrr auy p~•rlinrnl f:~cl,, ~~i.h a. 5.,k ~,t ~~r•~pcrty ur I.usin.se. ur rclinquishmcnt of rmpluquu•nt :•t (unncr dumicila. tamu+~l ~~f lanuly [u nc~ti' dn~niul~•, pu[cha~r ~~f h~~mc. rtc.) E';'iL'i:7;:G CIiT1_n~2'•:i: I'; SCi?t_i~L: ~ IiOt~~STi:AD I:XLi~'i'!IU`:: If etzter:i.zig chi lc'.r.e:~ i.r. school, ple~.se 1 isL th~~ir :za*.-~es : . ~ - ~ - i I ~ fllf0 AM~ RECOROEO ; ST.IUCIi L'vUlITY f~A. ROGL ' ! ~)1 ~ RAS ; CLfRK i :.:.UIT COURT ~ ~ RFC~P^ v~~ f.En ; J~r+ 1 II 18 AN'75 - ~ ~ ~ ~ ~9f330'7 ~ ~ ~ , ~ ~ 1 I~URTHI:It C}:RT1t=~' tlz.it (~ti•~ll r~~~istrr al my loral acldress when tiir rr;~i~Uation baok~ rcoixn. aucl ~ tum{?ly ~~~ith .~Il other rc~~!~im~iunts c,t a l~;~al r~•,iclrnt of this Statr. 1 I~UIZ7~llt'R CI~:I:I II~Y that I ha~•. n~~ intc•nticm to rrturn tc? my forn~cr ~{omicil~, ancl 1 intrn~l to rrmain in . . . ~ Q / ST I U~I~ ° - -~C_s~'~_~T h C~ e- - - - - _ - , C'oun!y, ~ - - - - - - - - - - - - - - - ~ }~lori~la. (~;'tm:u~~.•~tlly. ~c~~~•~ ~ • s~ ~L~,~ . _ 5TG?~;ATiJ - - - - - ~ ,L" F, ~ r, ~ - - - ~ - - - - s IG:vt:';•URE . ~ . : ~ ti~~~c~~~i•tc~~and.:uh~rrihr.l l:.fi»r n~~ ti~i~ _ o: i ~ . : . ~o. ~ ~s~ { ~ ' , - - ~ t ~1 . ..f. '~~t,'--i-r~:t;t-~ Ti~?i~re:" u~~ R PUf ~A i~1.'.;itl: CI ~:rUT"?' CC~TIi',"C ~ ' ~-:-;r-: - - - - 1''1 ~ri da ~ _ ~ c : ~ • - ~ ~ : . ~ ~)~~~ll~' C~ ~_'I~: . ~ ~ ~ O'•'• (T~~ h^ r~~ ~t:J ~n .Su~~l6- itr :~n~l .~n••~~~ it h!rJ ~cilh l 1.•t6 (licuil l~~~Utl.:~nd d~~~~lr :~Ir ~cill~ la* A•~ct•,ur) ~ • . ~ BUOK ~.Ja7 PM,4 ~ x~ ~ - _ ; _ . .