HomeMy WebLinkAbout1270~~~ 28 X570
Declorotion of~ l~~4~~F!~+tixenship_
TO TS$ STATS AND COUN7`Y TAa A~SS8801;,
- 3t,,Lueie _ OpUNTY, 1rL08IDt:
This L my declantia® of Damkik and Citia~sbip in the Sluts et P'forida flat I am .lllins this dsy in
aooordsaoe, and in coaiora~ity with Chapter 258, section 999.1?. Piorida statntea. ~ .
I was locrosrly a legal resident ot____~ _..-11es ~r - - . -~[3.x~~in1~
tCt4)
end I resided at_---_-----__.?.Di-II et-------:- -----_.. However, I have changed mY domicile
~~ (8tra aid itu~b~)
to and sm end have been a bom- lfde resident c2 the sots of Florida ainoe_____-- ~~~y___---.~___day o~
_ ~aS~hRr , 19--~-, and I reside a .--~-------
(8tr»t and N )
-.County, P7o~~ida,
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end this statement is to be talus as my aecLratia, a~ cltisenship, actual ie8al residence sad aomkiie in
the, statce o2 FiorWa. - -
!~ ao~k1N ~ dd ~ to m~a~+~°y ~~.: d fem.....: e'i io~°b'swi` o~ .~7..t
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900K
1961 .IAN -3 PH 12: I
ROGER /SITRA3 CLERK
$T. l~~l~ ~E6UMiY, f'LORIO~
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I FU~TANR CSBTiFY thed: I wifl r at a8/ local address whoa the rssistratica boolu iropsn,
sad Damply with all othe~t requirameMs of a lepl raison: aE this fiats.
I I+'IT8't$NR C~Ii'I'IP'Y that I bave no iote~tion to ~ tD mar iormwr damldk. sad I int+sad to ranain
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