HomeMy WebLinkAbout1051 ~.~~a~~v ~
O~cluatlo~ o~ Do~Nail~ a~al C1tlsMShip
To n~ sT~?~ nwo couNnr Tnx ws~ssort.
s~. wc~E co~nr. ao~~ow:
This is n+y dal~ration of Oomial~ and Gti~r+ship i~ tlw SeiN of flaid~ th~t 1 an+ filiiq thit day in aooordar~a ~~+d
in oonfor~nity with ClwptK 2?Z. S~ction 7~4.17. 'e!~ Stat t. ~ / ~
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1 was f~ormkl~r a I~a! hsid~t of
l~Ci~r) ~Stat~)
and 1 rasidsd at ~ r v O Y . Fb~wev~ 1 havs d?~rp~d my dwnWl~
~St*wR and Nuenbar)
~ and am ac+d have !»M a bo~a fid~ ros+d~+t of th~ StaN af Florida si~os ~ 3 ~ d~? ot
~ ~97~ ~,d i~a. a~ ~ b~ 5 T l~ at n ~
(5tr..t a~d Numbet)
l~OtT ~ SANT 111CE 001MITY, lLrOR~A
snd this stafarwnt is to be takaR as my dec#aration of ati~snship, actwl le~al ~~side~oe ar~d domiale in th~ Stat~ of Horid~.
Ansert h~e arqr pertinsnt facts. wd~ as sale af propsrly or business. or r+slir~quishn+snt of amploy~rr+~nt
at former dom+ciie. ranoval of family b new do~iitile. Purchss~ of home. elt.1
~ 20303'7
1.E011M8 ltECOR~ .
s~. ~~`~?ou'rt"m~
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~ 1~ ~ W~~~ COf11~r M/ll~I 01~1K f~]Yjfrfll~flK Of •~i~ f~ O~ 1~fif .~f.
1 R1RTHfR CHtTIFY thst I hsve no intention to return to m~r former domicile, and 1 intend to remain i~ FORT
v~~, sar~ ~uciE couwnr, Roa~ow, ~~,~r• l~/ar~~n ~Y. Co~~t~cy
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~ (µddross)
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Sworn b snd wbscsibed befor~ me this day of 19~.
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~r - O C. My Comrnis~ion ~cpir~s
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