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TU TNL`- STRT~ t1*3L~ Cc~Ut~}TY TRX ASSFSSC~R: ~•` `a
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This is my declaration of ~micile and Citizenship in the state of Finrida that 1 am filing this day in accarciancri.
end in cunforr=sity with Chapt€r 22?, Section 22.17, Klorida Statutes.
1 was formerly a legal resident of ~ ~ ;Sreon}
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and 1 resided at 'v$?~ic7 p~°~.Y° However, i have changed my dCriicila
!Strtet Ned ttivsnlwri
to and am and have been a borra fide resident of thg State of Florida since ~-~ ~ da of
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.?i,.,~,iia~ Oy, end 1 reside at _, `l, ( ~. . ,,
(Street end Rivrnbvr}
j~`~,,}'i~'C@ ~~.LUt.lf: County, Flofida,.~
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and this statement is to be taken as my declaration of citizenship, actua; legal residence and domirle in the Stgte
of Florida.
(inetn her• ants pN4int+nt fscre, such u sek of propaety or b.a~er»u, « re!inr~ielvnent of *rypisyrnettt et forrre~r domic!k.
removal e:f family rte new dw+eieti~: pur.hsse of trrtw, a+t.)
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1 ~La`RTtf~i? Ce~ilrY that i wri!# registrwr at ^r±y iocm? address ~vhar` ~a registration b~ks raoc~ri, afatf t~csmp3y 'ivitft
a;i tither r~u'iree°'aen#s of a 6~s- rrsider;t rf this. 'Mate.
t F11~'f~i~R ~~~lFY that i fsaae e~ int2snttz7n to r~tusrr to my fc?rr.-cer dc~nieise, amt's 'i ir.tenc7 to remain in _ __
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