HomeMy WebLinkAbout0984 a i i G/ i t C~ l N C 8 G~~~ J Ot \ C~ i~~+~
~ in the City of '~G r-t Sc,,;~r_ 1-. ~c., i 3~ cl
My mailing addreas is:
eren rom s ree a ress
My former legel residenca vas in the C~ty of_ ~c~ s~; L
State of N • ~ - .
(No fuxther statement is required. i~owever, if you wish, you may irisert any
pertinent facta auch.as sale of proparty or business or reli~quishment of
employment at forwer domicile, removal ot femily to new domicile, purchase of
home, etc.) ~ .
I F~RTNER CERTIFY I vill canply vith ell requirements of e Iegel resident o1
this State. I understand there is e penalty for perjury;perjury is a Felony
and~is punishable by incaration ~n Lhe State Department of Corrections.
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•PRINT NAME ~ SI6NATURE '
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! PRINT NAME • S~ZGNATITttE .
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~ Svorn to and subseri~ad before me this ~~day of , ig
DOU~1:~1:~' ~ ON~_ RjC C2xCUIT COURT _
8 ~~ci.. ~4 ~
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- RECORDING IpFORMATION
?Iotary Pub~ic~: S~~L. ot
yy Corr~mission 'tx~reas •
9U5795
. . ~ 26 PI2:40
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