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Declar~tion of Domiciie and Citiienshi
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TO THE CLERK OF THE CIACUIT COU~iT.
ST. LIJCIE ('AUIV1'Y. FI.ORIDA:
This is my deeluatioa ot DomieUe snd Citisenship In the State of F7o~Ida that I am 8lins thia day in aeeordaaee. aad ia
eontocmity ~rith Section 222.17. Florida 3tatutas.
I~as tormerly s kgat resident o! Pasedena ,(7e~lifornia 9u45 and I
IGYt~I l8tat~1
nsided at 141 Glensuuaner Roet+d . Ho~vever. I have eMaged ao~ domicile to
1&eMt asd Nts~)
aad am aad have beea ~ boaa fide e+~sident ot tbe State ot Florida since day ot
;
19 , aAd I rsside at SEE BII,(~n1 ~ y
(BtrMt ~d Humbrl ~
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Counsy. F'torida. _
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and this statement is to be taken as ~r declaration oi dtisenship. actual bgal residedce and domic~k in the State ot Flocida.
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I am a member of the US Arn~ed forces and am moved from : ase to base on US
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Gover~nt orders. ~
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I have purchased property xith General. Development Corp inSt. Iucie Cannty and ?
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intend to retire tnere. Qq(~` ~
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I FUKTHER CERTIFY that I~vill register at my keal address rvhen tbe registration booi~a reopen. and comply ~vith all
other requirements o[ a legal resident of thia Sbte.
I FUBTHER CERTIFY that I bave no intention to return to my former domic~e, and I intend to remain in
, _ _ _ _ _ see _ abov_e _ - County.
-
Florida. permaoently.
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~Ham.) Jerome A. Burchette
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05 Glenrock Dr. Fayetteville N.C.
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Swo~ to and subscribed before me this ~ y of
A.D.19 ? e -
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Pnbik Stat~ aiil..ii~~t I.rp
My Commisaioo e:pires ~Y~~ /
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ITo be exeeuted m dupBntt aod orisiod 8Md wit6 CIRk Cieedt C~et. aed daplieat~ wit6 Ta: Aw~1 ~
BO~K~~UJ PqCE a/V
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