HomeMy WebLinkAbout2493 D~claration .of Dar~;c~~~ and Cit~~~r~5i~~~
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~i~u •riii~. s-r,~'ri; n~i~ c•c~u~-i'~' ~i,~x n~si ~~c~i:,
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'I~hi~ is m~• drelaratic~n c~f 1)on~iril.~ :uul ('itir~•n:tii~~ in th~• St.it~~ c?f I~Ic?ri~ia lhal 1,:m iilin;, lhiti ~lay in
:«cordanri•. :~n~t in conlormity ~vith S~rtion '_'_'.17, I~I~rid:i Statut~s.
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1 was t~onmrl~ a k~al resi~lrnl c~f - - ~
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residr~l at /y/0 ;~~~-G2_~~tt1- _ PS•~----- . Ho~v~~•rr, I h;ivc changccl my Jomicil~ to
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(S •rt anJ Nmnhrr)
and am an~i havc brrn a hona lidr rrsid~nt of the Sta1c of I~loricla sincc~~ day ot~
- . 19-7-0~-, and I rrsid~ at ~'r~1..D _!l1'tr ~ - ~
~ (Slrret and Numbrr)
~GL2 ~ ~t = ~tGe.ce~ County, Florida,
' (c~~y)
and this statemcnt is ta be takcn as my declaration ai ritizcnstiip, actual Ic;~al residen~e and domicilc in the State ,
of Florid:~.
(Insrrt here any pettinrnt facls, such as v~lr of pmper~~~ or hu~inr~s, or relinyuishment oi employmenl at formet
doinicila, remaval uf (amily [o ne~v dumicil., purchasr of homr, ete_) +
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f~l.EO AMp t{ECOA FD
ST. iUC1E Cp11MT1r ~
C~ AKCC
~Ct~jiT OURT
. RECORD VFFtFlEb~~
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! FURTIIER CERTIFY that 1~~•ill rr~?ister at my local address when the registration books reopen, and ~
comply with ~l) othcr rcquirem~nts of a le,~al residcnt of this Statr.
1 rURTHER CFRT[FY that 1 ha~~e no intention to return to my forn~er domicilr, and 1 intcnd to remain in
lt'L~ _~C~-t'>'tf" c.7~ Gl ---T- ~.G~2f C,« , County,
}~lorida, pcrmancntly_
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S>~'vrq~~ ;ai~t~~111`~nb.d b~for~ mr thi, _~lay of
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''~~,:.~~c~ - - A.I). 19~Z'
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'~Y f'ublic $lelr .nJ~ at L~rac
G-s.c~ / o? y ~
Nty ('ommis,ion rx~,irrs _ _ - - - -
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(To be~tLatutrd in ituphcstr -rnJ ~rriy~u.d t~IrJ ~~~th Clrrk ('itcuil ('uurt. anJ dupli:alr w7th Tax Asscssor)
booK204 ~~2492
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