HomeMy WebLinkAbout0993 sTATE o~ F~.o~ioa ~eclur~ti~at of ~ora' ' '
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Th~ ~ q~y p~ddpp p(~ ppp~CltO tn th0 8tste 01 Florfds thst 1 atn filittip this day in eCCOrdattCe
and i~ corJo~~+ with 8~tloe ?.ZZ.17, Florld~ 8tstut~. ~
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p~Ma wra ~rouR ww awan
Decams e bons ild~ rosidws! at da 8tate d Florlds at~...~~~?v_~ _ 19~Y
and 1 res~ds e! ~',__^4.4~.~ .~.a ,
irt the Clty o! -~,D'f S`r ei 1_
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tvty maiung sddrsss lec .1.1`~/ ~ -~'W •C'~ •
af ornww~ n+o~r afa~sr ~ooatsq
. My forme~ tepa! residsnce waa tn the City of ..f"~.tT~ /~:EQ `
State o! _ /~'.L9~' _ _
(No tuRhet atetement !s r~equltod Ho~wsvar. tf You wtsh. You may tnsert any pe~ttneai tacts
such as sals oi propetty ot Owittaas ot r~itnqutahment of emptoyment a! tot,ner dtinitdle. remova!
ot tamihr to new doanicita, purcheaa ot home~ stc,~
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~ 1 FUR?HEA CEATIFY t wp! cornply wlth ep requireme~ta ot e teQal reside~t of th~ St~t~ i
understand thero ls a pensityfot P~1~Y. Perluryla 8 Felonyand Es pu~lshab~ by Ir~cerat~o~n it~ ths
State Departn~ent ~ Comsctlor?~.
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PRIN~NAME ` GNA R8 ~
PRINT NAME SIGNATURE
THIS SPACE FOR.RECORQING IqFORM11?~ON
s~«~ ~o ~ro.a e.t«~. eaa m~ `7~?E;~i9'~
of , 19~
' JUP~ 19 P 3 :11
ROGEft POI , CL8 ~t~~,,~` . .
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`~ovnrv,~' '
Notary Public~ State of. ~ .
My Coom~iesion expires: •
~a ~.M++tAMt~ ~8~81~ 0 QK VO~ "r •,i,f i7J~
00
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