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HomeMy WebLinkAbout1622 Dcchuation of Dom.icile and Ciliz.el\~hip !) ~ A" 'J" eJ~~ 't.J i1.(! ~b(J TO THE lirA n: ANn O.1UN'TY TAX A:~n:SSOR. ..1' LL'e!!:.: ('()~'s'r)', n.OIUDA '-. r I..'~ f C .L.~1.1,;; A. Thi.t Ij nl)' .-t..d.tiHi::m o( l>t;..n!n.. and Clttr~nshl~ I!} ttrt' Slate or n"d<~ that I Am hlmi Utll Uf.)' In aCt'On\i1[j('ot a,,<1 In ~;lr:.rom'<lt.... With Ct.eptu Ln, ~1!Qfl zn 11. Flor-l.;5G 3!!\t,,1~' t ... "'. (ormulJ' , lee.1 /'tl,d.mt of. ~~ ~-cA1a-. --- (City) .__J~ t. _ C uX:Y..lJ r;!L '___ Sh; t& 2915 ,"111 U\on Rd. I:-nd I r~Jh1r.-tl at -__..._____~________~_._._~__,_''" ..--.------------.-... }(OY.tl,H. I tUhf< <:ruW.N 01)' d<;om.:~ (su~t a:ld Nwnt.f.rl tn v;d ~'"l'I A'xl ~""''1' \-"'1 ... l>ut... n..1~ rnlWitnt or the Slaa c.t Jo'k-,t,-u ~~ _._____. .13 th ._______.._.., __.~___.... <liS)' vi _.__. A~I..lJ.:;' ~.__._,_.____.__~__.._._ -'- . ~l 19 ...-. .~::.~ a.F\d i r..t~k a 1 . St. Beac.h JOb.'-'f'rrt:t rHt~8-' .----- hlr~t and rHi:n~r I "'ORl' 1'1 Eiter:, SAlI'l LVCH:. COV~..'l."I'. n.OIHL>A, A!1d \h.. italt:n..1'1\ IJ It) W Uk~a Ai my di"{lu.t.on of d\llttnlhip, ....:tcusi 1";':.Jj r~idtll~ an I d0m~ilt' If"! \I!~ 'jli\~ (J<t f1ood. [In.f,ert h{,l~ Ilry r-<;i\\Ol!"'1 tFt\ fu,h at uk or pr~t!.y or buSintM._. "r T\?!lf"l'H!r.mt'tll r;! '-";;plO)'111t..nt .: 101.....,( do;njnlt, ,€,,'o'al d iJmHy t;1 n~\Oi df.1l1ll,:ll" p"rd"'e~ ,;,( l'wm~. .I..} Ell!. t3ri ng N liD. Dawn Ran~iOn 1 n th e 1st grade L.i'l i I (lB{ )~~!) flUO ANO RECOROEO . f'\Uir'\;1I\ Record 0(,,11 I~' \,1,\1",'" I~l Vf\ \1 ___~ ------.- 19t i AUG;: 0 p~ I' 42 ',-, '~'..J' , . _;. :;~ _~ 4 ~~~' , l' ~..i, J1-. ']4'~. :n o. f r '~. I 4 i.{ , IT. ~. 1'1 r" " POll U,-,... .', I ~ ;, a'H~.>{tl~ ... .' ... nor~F:R 1'., .' ". ".,. '.: ~/ -"~ ........ ..~ ; ...: I }'I}H'flll-Jt CLJ'tTIFY Ua: I wilt (V"ilJlo:'r 1I! my ltxa! a.}.j".,,) wb",n thl' r~iillflltl('n l.;<;(!k..c I"'-),"~f.. aN;! <'<..""'V!)' ",jth 1111 cU',t'; I<e<.l;;u~mentl e.( . legal a!id~nt Dr tlla S!li.le ; fT HTHF:H Cf:HTn~Y ~"/lt r h"ve no hll!:n\wfI 10 n tUJr. to m)' fOr? (l<ftnkii~. H.{i I ll,!<'r.<l t,~ rt"n~.\I' i.n milT PlmCl, "''''' LCelf, ('Ol'~T', Tl.011l[)A, .."".n.,,">', . > /J -k~/;::) 1~:~Z~::~:~~~~~~3::,:'.=. ...___. ... r:n r 1 R. !tt'U1B on ( A'jdre-u) Sworn tiJ llnd ~'Jb~'rH-'f'tj wbril If>!! tha...._____t;Ctili_,.,__,._illy ~.. Au 7\. {) t , .. "_- t,,-. .....' 62 ", l~ HO(iii't\ POiTRAS /" i-I rj>L' i"I'i,'l'j. COl'I'" /-,,~.....n..'-'ZJ' ~," ~-~., ~::'~-L~,I!, ~~-;.Jf-.t!l! 1): _.'--_ " ; ~ .2,..:' {l C.~~~t;;(~.~ -. <~.::."" .- i';(i~.ty J\J-,Ik l~.C-. ,.... ,T-, -,,{.y. C?'rl{,:wn };;>n' 'f' " l>lr~ _ ~. . ''''-.,! .-} '- . '\.." . ~ ,-. _.."'__.0._.__ .,. . ._~_..~.__._.. ,,~~_..___-._ .....___._._.. __""_~~'_"'_~_..,;.,..~..-~.-.-,.-..--..-. .......".~. 11'0 I>> ,,~;x~t!!ld hJ dt1~lr-.lt... llM orltm1.l filM w~t..'l (}~~,'~~ ~.'-.~._._,. -- --, . $.l:'~ th!~k1>tf1 w~u. ~'li<,1t .~~) I 1 J