HomeMy WebLinkAbout0155- i 20~
~ w-~
- Declorotion of Dom~icEi e~an~~~itizenship
TO THE STATE AND WUNZ'Y TA% ASSE13i30R,
s t. Iuos• oovrrrY, x~,o~s:
This is my decoration of Domidle sad Cia:ena>sip in the State of P7orida that I am filing this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal. resident of._ YOntre4l __-________-__-- ~----------------____-, _-_ ~eIIada~__-._____-_-_-•
tpa) tat.t.)
and I resided at__._._ _1670_-CQ~! ~_~~-~ ~ 11t _ Let~eat____, gowever, I have changed my domicile
_ t3tr~t amd Namb~e)
in ~tp;~ ~sn w~ri 1-snta ~ w t.r_:rs. =+r3g. ~_-w,iit_~~ :~F tk_ t»::. n{ T~'Inri:~A gtin:~a ~-+~ .-~r~ .~~
~~
. ~ 19 ~, and I rsaid8 ut ~4].4._~11t~S~--------------------------
-_-----------~~--Pieroe u__ ~e• i•uola -----.___--County. Florida.
and thin athtement is to be taken as my declaration of cit~zenahip, actual legal residence and domicile in
the State of Florida.
i r~m~:rt d mkil~s. r mo~~ ~ am l~~to t ~domieII~. p~ce~ ob ~~ or~r~liaauish~rai at omploym~at at
9~if'7
-~ ~~.~ ~ ~ in P ~ ? ED
i~
1. JJL11 ICU I~KM~.1, u`r-ri
Si. 1UC1; COUNTY, FLU;t,~,Q
- v
... .^
. -;s.
.-• is ,~.,•
t''' `
. ..1~~~
'~'.f r.
I FURTHEB CERTIFY that I will register at my local address when the registration hooka reopen,
and comply with all other requirements of a legal r~esldant oZ this State.
I P'C~'!'HFR 4'ER7'IFY that I have no int+!~! to re~rn to my foruu~r domicile, and I intend to remain
~ - _ ?o rZ Pi srn a .._____~ 3t . Lne ie ~ty~ Florida,
tGa)
p~tb•
irt$ar L•aaard ~ .
Swarn to and su ~ ~_ ~, " •,~-e thia..___~_._dy- o~
A. p. 19! ._~-
/ t~ >~•
se... e•rNs a.. ~-ab: tM. ~
_, ~.