HomeMy WebLinkAbout2463 - Dec~aration of Damicit~ and Citizen~hip
2345'79
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~Thi. i. m~~ ~1.•cl::r:itiuu ut~ I)c,miril~ :~iul ('itii~•n,hi~, in th~~ Stalr ol' I~Ic~rida that t a~n lilin~: thi. ~lay in
accur~lanrr, ;in~l in c<~nl~c~rntity ~vith S~rtion ~,,.17, f~lurida Staltttrs.
1~vas form~rh~ a Ir;~al resictrnt of and 1
,Q ~I ~~c-~u~> (swcr~
n•.i~lcd :~t .~~l._~ ~1~1 . Ifo~~~c~~cr. I havr changcd my domicilc to
( 1 anJ Nun~brr)
ancl am :u~d hav~ brrn a bona fidc r~sidrnt of thc Statc of I~larida since _ d ~'Zday oi~
- - • .~nd i r~sid~ .~t T~- ' ~7G~ ~ -~Ce..
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y v, (Street and Number)
---.~L ~ County, Florida,
(c~~>•) .
and this stat~ment is to be takrn as my dcclaration of citirenship, actual le~al residence and domicile in the State
of Floricla.
(lnser: hrrr any prtlin.M f~etc, such as sale of proprrty or hu~inrcc, or rclinquishment of employmrnt at former
domirilr, rrmo~al uf famil>• to na~c domieil~. purchasc of hmne, rlc.)
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2345'79
FIIfD ANO RECOROEO
ST. WCIE CDUNTIf flA. .
ROCEk POITRAS `
CLERK CIRCUIT COURT
RECOR~ VEn^cF1E0~~...
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1 FURTHE:R CERTII=Y th;~t 1~vill mgister at my local address when the rcgistration books reopen, and
comply with all othrr rcquir~ments of a le;~al resident of this State. -
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1 FURTHt;R CERTIFY that I ha~•e no intention to return to my fornier domicilc, and I intend to remain in ~
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, COU11~}r~ ~
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F~lorida, pcrman~ntly. ~
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~ o R/?%C C (Name) 8AR %C ~
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S~+~urn to an~ ,ubsrrib:~l hcf~ar. mr this ~2~ d:~~~ of
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=i •I7'o h~~arculrJ in dupti..~~r rnd un~ i~~.~l idrJ ~~~th ('Irrk ('ircu~t Cuurl. anJ JupGcatr w~th Tas Acxssur)
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