HomeMy WebLinkAbout2620 ~~~'~,r~~E~~ a~` ~~~ic~~~ ~:r~~
~ro ~r~ii_ s~r,~~ri: ,~;.u c~av~~i~~~ ~i~,~~ nssi:s~~~r,. 234'703
- ('UU\'1'l', I~ LC)Itll)r1:
1~his is my clrclaralio~i c~f 1)ontiril~ :~m1 Citir~nshi~~ iit thc Stat: ot~ f~lori~la tliat 1,~nt filinr lhis day in
.~cc:ont~nrr, an~i in coni'ormitv ~vith Scrtic~n "_'_.17, ~lorida Statut~s.
I~vas formcrly a Ir~,:il residrnt of _/`~v l~~ , ~ and 1
cUY) ( ta~c)
residcd at ~ ~~'~~~~~-;~i~ ~ e~ . Howcver, I havc changrd my domicilc to
(St~eel and Number)
and am and ha~e bccn a bana fidc rrsidcnt of the State of l~lorida since day oi'
_~ov s ~ , 19_ , and 1 residr at `~^'~i°^~ ~1~"~--~
~ . ~ Streel_and Number)
~O~Pl c~7` ~v~i c~ /~O /P~[' e~ D I~. ~ County, Florida,
(c~~r)
and this statemcnt is to be takei~ as my declaration of citizenship, actual legal residenee and domicile in the State }
of rlorida. ~
(Insrrt here any prrlinent facts, sucl~ as sale of properly or Ausiness, or relinquishment of employment at former ~
domicile. removal oi family to ne~v dumicile, purchax oi home, rte.)
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t LEO AND RECORO j
ROCER~PO
TITIAS~ ~
C~6RK CIRCUIT COURt
RECCRO YER~FIEO
Auc ~ 1 i 23 ~M'~Z ~ - ~
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1 FURTIICR CERT[FY tl~at I~vill rcgister at my loral address whrn the rcgistration books rcopen, and
comply with all other requirements of a lc~al resident of this Staie.
I I'URTHER CCRTIC'Y that I liave no intention to return to my tormer domicile, and I intend to remain in
<=~~Gi~ ~uv , ~ ~ cc«~~ , County,
Floriciz, pcrm~cntly: <<'"'~
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":~S~ot~ to aitd ~~~iecl h~ fo~~ ~~~c Ihis 'S` day of
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Nobty Pub6~ Sl~te uf I InnJ~ rl 1 arir
A1y Cc~mmi~.~ion rx~~ires------------------ - _f'" C''~e.e J
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~ (To Ix r~eculcJ in duplicilr ~nJ orii~in.~l tdrJ ~si1h ('Ir~k Circuit Cnu~1. anJ Juplw•a1r ~vith Taa Asscssnt)
600K ~4 PAt,~ ~19 .
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