HomeMy WebLinkAbout0347
Dettoro~io~~~°~~~e and Citizenship ~ ..: ~ .
TO TS$ BTATS AND COUNTX TAZ A88S880R,
a'P. L~CIS COUl~'1'!. lLO~tIDAs
This L my declaration of Domirlls and (~iaenstiip pt iae 8taie o~ lrio:ids iaat i am niia~ iris aa~ is
accordance, and in ooniormity with Chapter 282, Bastion 222.17. Florida Statutes.
I was icemerl3- a Segal resident oi-~~4~--. ia[Rs) ~~`' cs~•) ..
:~ I ~w«~o i st _RI3 ?-ttara~r -----._.-- _ _ ~etev~, hsve ---'" _ rnlr a.±m~;~
-- (8t:est sad Nmrbsr) ,
to and sm and have been a bona lids resident oat the Slats of P7orWa sinix_________-___9th----------_--_-_d„y ~
18.E-, and I reside at_._ s~'1 $.._1Qt>s 8t _ _
t8tewt ana I~uaDse)
!'T. PI1~S
8'!'. LUI~IE CO
__-.-County, Florida,
- (C1b)
and this statement is to be taken as my decLntion of dtiaeoahfp, actual legal residence snd domicile in
the State of Florida.
((Invert ha+ w vsrlianl lasts, suet as sab ~ vat~r or budasss. ~ roW~pccisbm~nt al sssvlol-set et
tor'tsr domleilsr ssaw~al ~ lassib to new dossidie. pow d l+esss~ mss.)
i
912`7
t ECDR7ED
FN..E A. ~D R,
. ~~ n ,
~~ - - .
~. ~ f>tll:;t.~~
ti~~.~ yf\
~.C ~ ~: . ,; r~ .
/~'',~ ' J t , i' , ' L `~
~~~~~/~. :tit..
I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
and comely with all other r+eQUirementa of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
~------FT~__PILACE ____---------------------____-. ---,~-I~Z~__~-___ -----County, Florida,
rc~sc.~
permanently.
(Nasss)
' ----~~•-Y40~i---------- -----------___-----
(Ad~rsss)T
3WOrn• ta. .~tt~p4ttbed before me this__.9#.h__day of
~_;-
-' C k Cironit Court
~nY ~ - - _-''_.- ---~--
'~
D C.
(Ta bo tzeeutsd in duvlkato original ebd will, Clot Clrsoit Court. asd davlkato will, Tau Asssssosl
BoRS ssya~~ ~••, pcanc acr. r~..