HomeMy WebLinkAbout2521 ~lr~~t~~"c.~~~~n ~it i"~~~:i~-^. G~"i~ ~i~~~=~~ ~ii~ ~
234625
~ro'riii~ s'r;~~ri: n~uc~ou~~i~~'r,~x nssi:ssc,it.
~-4_ - C'UU\'I~Y, l~ 1_Ultl l)A:
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"1'his is my ~Irrl;ir:~lion al' I)~~micilr :~rnl ('itir~•n~hi~~ in thr Stat: of f~lori~la th:it i am filinr tlii~ day in ~
acronlanrr, a~ul in cc~nfc~rmity ~vith Seclion '''".17, l~lorida Statt~t~s.
1 was formcrly a Ic~;~i resi~irnt of _ ~ t
cib~) ~ ~ (s~ate)
residrd at :11 • . Ho~~~cv~r, 1 havc chan~cd my don~icilc to
reet and t~umb.•r) ~
and am and havc Uccn a hona fidc residcnt c~f thc Statc uf l~lorida sincc day of ~
, 19 7.~, ai~d 1 residc at ..l~~L3E~~~~~~~~~~• ~
~ . , (Slreet and Numbe~)
~2~?i Q , . I dR - County, Florida,
(c~ir)
and this slatemc~jt is to Ue taken as my declaration af citizenship, actual lcgal residenee and domicile in the State ;
of rlorida. I
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(lnserl here any prrlinent facts, such u sale of p~operly or buciness, ur relinquishment of employment at former ~
domicJe. removal of (a~nily to ne~v domicilc, purchase oi home, rtc.) ~
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234625 '
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fILED AND RECQROE~ '
S~. ~UCIE COUNTY FL . ~
RQCER POITRAS
. CLERK CIRCUIT COURT
RECORD VER:FIEO~,~..~,~
_ A~ 3 2 v6 PM'7Z~ ~ ~
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1 FURTHGR CERTIFY that 1~vill rcgister at my local address when the registration books rcopen, and
comply with all other requirements of a Ie~al resident of this St~te.
I rURTHI:R CERTIFY that t ha~•c no intcntion to rcturn to m fo er domicilc, and 1 intcnd to remain in
~~,f ~c.l2~1' , ~ County,
Florida, pcrmanently: (c~~r~
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. < (Name)
- ' ~ i r? -~l ~ . .
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(AdJress) ~
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rt+o'' d~Uscribcd brfor~ mr this Jay of ~
WQI~ r: ;1 ti ~i~,` . .
..,t~~- Lc , A.D. 19.~ z-. :
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Aty Commi~~ion r~~~ires--.- - `t'-`~~ ~1~~(v
(Tu (ra cxrcu[cJ in Jupli.:dr an~i ~.ri; in.~l (drJ ailh llr~k ('~rruit Coutl. anJ JuplNalr ~vilh Tax A\KiN~f~
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