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DECLARATION OF DOMICILE
STATE OF FLORIDA °
COUNTY OE' ST. LUCIE
This is my Declaration of Domicile in the State of Florida
that I am filing this day in accordance and in conformity with
SECTION 222.17, Florida Statutes.
I~ ~ We ~ Guljord, Irving & Lina B
tplease print your name clearly)
became a bona f ide resident of the State of Florida on November 27 ~
19 90 and I reside at 8003 Lakeland Bv ,
i.n the City of Ft Pierce, Fl 34951 ~
My :nai 1 ing address is : 8003 Lakeland Bv -
s
(if different from street address)
V!v f:~rrrar ~~r~~ ~ rcci rlor~~a e.r~o i r~ 4-he !~i ~~s ~F Carita Arn~
a~i avLti~~..~L i~...~Y ii~~.1 1...1~~t. tiLLJ i~• Vt{~ \r1iiS Vi - ~
State of CA '
(No further statement is required. However, if you wish, you may
insert any pertinent facts such as sale of property or business
j or relinquishment of employment at former domicile, removal of
~ family to new domicile, purchase of home, etc.~•
90 JAN 26 P 3:O 1
142178 3 8~1
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I E'URTHER CERTIFY that I will comply with all requirements
~ of a legal resident of this State. I underst~nd there is a
~ penalty. for perjury; perjury is a felony and is punishable by
~ incarceration in the State Department of Corrections.
I Irving Guljord Z~ ~
't PRINT NAME SIGNATU
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~ Lina B Guljord ~ ~
F
€ PRINT NAME SIGNATURE
~
~ Sworn to and subscribed before me this 22 day of January ,
~ ,9~-.
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~ DOUGLAS DIXON, CLERK OF CIRCUIT COURT .
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BY: '~~a , ~~l ' '-;:_s
Deput C1erk - : v ~
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NOTARY PUBLIC, State of Florida
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MOT~Rr Ptt6L2C STATE 0~ FLORtDA
~ MY COMMISSION EXPIRES• NY CC~1ISSi0~~ E7,P, oCT.t3.1993
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