HomeMy WebLinkAbout2660 Q~c'~r~.E~n o~ ~ori~~~:~~v ~r~ ~i~
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~rc~ ~ri u: s~r,1'l l~. ~\1) ('OUn'I l~ ~i~,~x ,~ss~:ssc~it. 234'72'7 ~
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_.~G!?G-. -----.('UU\'I~Y, !~LUit1U,1: ;
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This is m~~ ~lrrl:~ra~ion c~f I)an~iril~ cu~d Citirrnslti~~ in thr St:it~ ~f ~loricla that I am Clin~ lhis day in
i
accordancr, ai~d in canl'c~nnit>> ~vitl~ Scrtian ~'_~.17, florida Statutrs. ~
1 was fonnerty a lr,~al residcnt of ~ and 1 ~
~ (c~~r) (s~~c~~
resiclcd at -~~3 S~~ ~ Ilo~vcvcr, I havc changed my domicilc to
(St~ert and Piumbe~)
and am and have bccn a hona fidc rrsiclrnt of the State of Florida since day of
, 19 ~'~,2' and I residc at - ~ ~ ~ •
~ , lreet and Numbc~)
~ L~ ' .d~ . r.~~~~ COUIII~I, F~OtI(~~1,
(City)
and this statemrnt is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(lnsert here any ~+rrlinent facls, such u sah of property ex business, or relinquishment oi employme~t at tormer
domitile, remo~al of family to ne~v dumicile, purchase of home, rte.)
~u~Cc.u~.c. L~ ` ~ ?~'2~y
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iT.l~lCIE COUNTY ~~A,
CLER~I(~Ct~CUIT COUAT
RECORD yfRtF1E0.,....,~,~
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1 FURTIiER CERTIFY that !~vill re€istcr at my local address when the registration books reopen, and
comply with all otlicr rrquircmcnts of a le~al residrnt of this Statc.
1 PURTHI:R CERTIF=Y tl~at l l~ave no intention to return to my former domicile, and I intend to remain in
• (i .~'-l~('~2. , /.u'• c~-l-[~c'-[~v , County,
Florida, pcrmanently: (c''Y~ -
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' , l. = _ (AdJreu)
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Skrtii~rtc~~;~1dZs~~scribcd btfon mr thi~ _=_7_ day of
_ ~ ~ ~~1 titi• ro~-
~~~~t~` A.D. 19
~ ~ _~..E.t,G p~ - .
~ otary Public tilale u I.~riJe rl La?c.• V T
My cc~mmi~.,ion rx~,ims /S -/~710
C/"
~ (Tu be e~ecuted in dupli.aa• rnJ un~ i+ul (drJ ~~ilh l'Irrk ('ircuil Cuutt. anJ Juplw•alr ~vilh Ta; A~uw?r)
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