HomeMy WebLinkAbout0499i 5~:
Daelorofion o~i~~nd Citiz~nthip' - .
TO THE t3TATR AND 00UN'1'Y Tftt7C A~84~, r
3'!. I~C3= Q0i1N'~. p'lep>RID~A:
This b mp dec4ratico of Doaniaile am3 (!S~ is the State of Ffoe~la that I am ~~ this dsy in
accordance, and in oooiormiy with Chspter 282, $eetioa 228.17, Florida Statutes.
I was iccmerlY a ~ resident oi ----'-' tsta)
(db)
-*-_.,
_ - a20 Hoer lie -----------------__-• However, I have ahan~ed my dva+~
and 1 resiann at----------- ---•-------- -------------------------
($troat aad Naaboz) 15Lh _____-•-dsy of
to and am and have been a bona tide resident of the State of Florida since- ---- ------------------- -----
DgC~R _-_-- -_--= 19 and I reside at____~dS fir;' ...~~.~_._._--
--------=--_---- _.-_ ----~ _ ice.: s:.'. **°~>4..i~____------------
l+!1~ lpIERCZ ~ _-- S!._ IACIE _.___~____~_.~-_CiOllnty, Florida,
------------ (Ctb) residenos and domsicile in
and thin statement is to be taken as my decLratioe~ of dtisanship, actual le~si
the State of Florida.
((Invert biro am yertinwt facts. such sa salo o~ ,proD~77 or bosiaoas. or rolinVn~a+t o~ tmDlo7~t at
tormor doasidlo. romo~al of fam117 to now do yorebaso ~ 1oa~o. ote.)
. ~/
III~IIU1+lul/f=/ .
~~,~~ .. fir';
._. ; `;~ ..;; ~ ._ ..:: ~ . 913
ff f:: fllfl1111,
Gib Fn_eND RECORDED
It`I,~~ - .. DOCK
~:~~`. ~ I..S~
f:~JGER COU RY fLORf ~ A .
S;, IUCIE ~-
I F`U8'1'HER CERTIFY that I ~~~ *e:±stcr at mq local address when the registration hooka reopen=
WiLIi all UiuCr rcyuic+++~ ±`w ~f ~• ~~~1 r«eidei;tvi tt.io .°.s ~.°•
and comply ~
I FUR.TAI;~ CERTIFY that I have no intention to return to my former domicile, and I intend to remain
_:_-LQC $----------------------Count3-. Florida,
~•---PEE--------------------------•~ -----_--~T
~-------------- _ (cxb)
permanently.
f-f •~~ ~~~.~~.~•P~ ~or+s me this__l8ithday of
------ f`i"R (Nano)
----~~-~.--Y ~~ ----------------------
Clerk
(To bo elcoented b duDlialb and oris~oul Mod
C'wri~ Cireoic CooYt. sad doaiinlto wit\ 11a~t w•••••or)
Rnwn snDD17 CO.. Plant 0117. ~O•