HomeMy WebLinkAbout0920 STATE OF FIORIDI~ DI ~~a~O ~t'~
COUNTY OF ST . LUCIE
This is my Deciaret(on of Domiclie tn the 3tate ot Floride lhat 1 am fiting thla day In accordance
and in conto?~+~+iw with Section 222.1 T, Florida ~tatutea ~
1, (yye~, Miohael D. Helletrom
• (1'uAOt rwNT r'~OtNi wWH C~EMtY)
became e bona flde rssident of ihe 3tate oi FloNda on October 29 ~ 61
and 1 reside at- ~ 1201 Heron Aven e ,
t~ the City ot_ Fort Pierce (Florida) _
. ~
My mailing address !s:* ~~n6 1 a Puante Cnurt, Apt. 139
~ a~r~nr ~ stt~[Er ~aoaESS1
Tam~}a_ Florida,_,,;~617
My former fefla! resldence was in the City of Tal l ahassee ~
State of Fl ori da -
(No fUrther statement ia req~lred. How~ever~ if you wish, you may insert any pertinent facts
such as saie ot property or bustness o~ relinquishment of employment at forme~ domicUe, removal '
of iami(y to new domicile. pur+chsae af home. eta) '
i
* The Fort Pierce address is my permanent address, '
and the mailing address shown is my temporary ;
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school address. i
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t FURTHER CERTIFY I will comply with a!! requirements of a legal resident of this State. 1
understand there ts a per~tty tor per~ury; perJury is a Felony and ls punisheble by incaration in the
~ State Department of Correctbns. ~
Mirhapl HP11ctrQm ~
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ROGER POITRAS, CLERK CIRCL'ZT CT.
FIL;
gy ROGE:, ~ , , .
SL CU~ : i
Deputy Clerk j
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Notary lic, State o.f.~ ~
- r+'J
My Commission expirea ,a~-~~~~~ ~~T3.a~ ~;a,
FORM 20 : ~,'~y 25, 1989 ~
Ww~ i S~lw~o'/M. 6wA, Florfe, • jW ~ ~
. , :5.. ;0~49? ~ 918
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