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ST. UC COUIITY. FIA.
Declorotion o~ ~micile and Citizenship
TO TH$ STATE AND COUNTY TA8 AL~FAt308,
_ ss, zvcis a~UrrrY, FLO>~a:
This is my decletatioa of Domicile end Citisenship in the State of Florida that I am Alma this day in
accordance, end in conformity with Chapter 222, Section 222.17, Florida Statutes. ~ -
I w3.a f,^rmerly a legal raaldsat ol.r~Bdl~>~'._...-..-_...__---- -----------------------, - --- - ------~~- - - -- - -- -
-~nd Iresided at__dl'1__OralIl~lii.~____....._._~_--_------------- -----. However, I have changed my domicile
to and am end havo been a bone Ade resident of the State of Fiorlda since-- -_-- -8th . _ day of
T7lff!~f'R~ d~ ~ gnu • T.~J 2 . DI ..w 11w .
---____.~'~'~ .______.»., l~ , and 1 realae 86_.l+~i~»lkAiSi!»o +i.__=_:.~_`_'~_~~'. =i -_- -------_--_-__------_..
ri~_ s ~oa• ~CI~= ____.~_________._.._~_~~_._(iO11IIty- F~011da,
(C[b)
and this statement is to be taken as my declaration of c#tizetuhip, actual legal residence and domicile in
the state of Florida.
((Inert ~ w p.rtinnt t.d...neb a. ula ~ or bosioMS. os rlLgnl.bma,t of .mplo~mwt .t
torm~r domieii.. r~neo~Q1 a~ fadis to >ww domfew. ~ ad boa. its.)
Entering
Pateln •an HOlssa
is the Lad grad
,;. . ;
9122'7
F1~_= ~.P1G REDO QED
~~.~ ~ _ _300K
,. - -~
195, .,.~~'. ~ A,` 10.50
i~~~v~n N~ITR~.S, Clr.
S1. t.UCIE.000NtY. FLOacuA
I FURTHES CERTIFY that I will register at my kcal address when the registration hooka reopen,
and comply with ell other requirements of a legal resldeat of this 8tata
I FURTH$Ii CB.R'I'II~ that •I .lave no intentiau to return to ner icrmsr domicile, end i intend to remain
in__.1r._P'15~~. .____.., ~'!'. I.IICI= ,..County. P9orWa,
p~W' tCibl
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(~ 6~r aseeotei b d~eeq sad eel~al ~ ~ CMek-Cb+rak Oe*tR eaa de~lieete witk 'hs Aeeeeeee)
~~ eay1~ Cy.. T+t~nt qq, ale.