HomeMy WebLinkAbout1354ST,. ~(k~ CpUMTY~ FLA.
This is my declaration of Domicile and Cltiseaship in the State of R7orida that I am Suns this day in
TO THE STATE AND COUNTY TAB ASSBJI3SOR.
.Q~.1_ n_t I,nn i n QOjjNTY~ ~A s
accordance, and in confa~rmity with Chspter 282, Section 882.17, Florida. Statutes.
I was formerly a legal resident of ~ll~atsi~l~_ _______-___-_., __-___~ltew Te~li7_
(C[b) (State)
Sllq l T't~ltle-Q tai - Y..i-ra D,naA ..
.-•ro:.--~+".s~.----------------------------------------- ---. However, i nave chansea my aomlcue
sari Number) .
to and.am and have been a bona Sde resident of the State of Florida aince~~ls~._.___- ______________day of
- ---Lecemoer____________________-__, 19-_n~ and i reside ac___-____~..._jnuian -ui~s~~i~4----------
~~ :ate xnm*_er)
- - -------l~ort_ Piero• _ ----~ ~---------- St.Luai• ~ ~_~4,. Florida,
- (at,)
and this statement is to be taken sa my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
former doaieih~, rem~ialla ~it~r ton ~domieile. p~nrehtt~ ~os~t;linQuiohmtaot os omplo~adwat at
Homestead
9195
~--------.L'ott-Pi srn e ------------------------------•
(City)
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I FURTHER CERTIFY that I will register at my local address when the registration hooka reopen,
and comply with all other requirements of a legal resident o! this State. _
I FURTHER CERTIFY that I hsve no i_R*~ntioa to return to my former ~lomiciie; and I intend to remain
Sworn to and aubBCribed before me thia__=_~31_-.day of
Qectorotion- o¢ Domicile and Citizenship
FII.E~! ANO RECOROEO
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tWt--r ~- A_ M `~= t ~
ltibl M .t~ v
~,.-, ~ tR p01TRAS. Ctf"~
. t'JCIE COUNT'I. F ~C., t1
State Ot lrlorida at I.arp
My Commission ezpiree._.____~5~._? !~ 9 fl~
Rn~.n BUDDIT Ce.. Plant CIt7. Pls.
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•y
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rye rL, • . ' 1 t ~ ~~
Florida,
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(To be a:emted in dnplkab and original fUed with Cleslt Gait Conn. sad daplieate wits Tn= Atia>.ssor)