HomeMy WebLinkAbout0976 ~ . ~ ~ ~
STATE OF FLOAtOI~ '719510 ~
C:OUNTY OF ST . LUCIE
This ~S my O~claratio~ of Oomldl~ in the 3tite ot FtoNda that i am fitin~p thls day in acco~dance
and in confo?a+iw vvith ~ction 222.17. Fiorida 3tatut~s.
~tw~, P uaoN~~r. X 1RT1 13ANC-N p~.~ ~
~ ~RtneE ~r ~roup wwE afJ~n
b~came a bona flds rostdsnt d the 8tate of Flo~ida on ~ nl n,~b~~ 6 3 '
~7.-~-._ ~
and 1 rsside at~ z 9, S•.~ .-r ~P.• o R 1 r d "
~
M thar Clty of- Pna~• .l•~ . _~i r i_ •334~ ~3
My maitlnp addrosa ia; _ 3-~ q. S.w _ [,~.E~~v C{ l,~
a T FROY 8?AEET ADDf1ESS)
~@ ~f. s~+. c..,~<<; ~ 33 ys3
My fonr~e~ lepai resldance was in the City ot _ F-1-r 1I ~ N aA ~•.r .
State Of.~ j .r ,4~
(No further t~tatement ia required. HovMever~ ff you wish. you may i~sert any pe?tinent fact8
such as sals of {xoperty or bu3lr~ess or retinquiahment of emptoyment et former domiclle~ removal
of family to new domicils, purchas~ of home, etc.)
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F
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i FURTHER CERTtFY i witt compfy with a!t ~equirement~ of a tegal resident of thla State. !
understand there ls a pe~alty for pe~ury; pe~jury is a Fetony and is punishable by tncaratian fn the
State Department of Comsctions.
!~C t R i~ B~±~~ n~ ~~d oNi T i~'f~i~.~ t,,:.~
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'7~9510 ~
9worn to v+d subscrib~d beton nM th4 ___1_~3 _d~y r
' ~,0~""'r~• ~19 ~ f AlA 13 ~ 1 :Q6 ~
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~ R f~ ~#~9fT~A3 CLE CIRCL'IT CT, gQ~ER POIT~;,:'' ;~~~~x ~
. ~s, T. LUCIc CJI:~i~. f~
~ ~ '
~ : Deputy Clerk
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Notary Pub lic ~ State of ;
My Comcaission exuires : '
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FORM 20
w.... a suwnoy.,. aMwn. Rorw. ( s e a 1)
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