HomeMy WebLinkAbout2755 ~~?~~~~~'c~~cE~n O~ ~C3:iZ~~~~~ ~:t i'~ ~t~:~~~ ~
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'rc.~'riii: ~'r,~~ci~. n~i~ c'c.~ta~~r~' 'r~~x n~st.s~t~it. .
Ul-~ ~..~c.1.•Cc.~ - - ('UU\"IY, l~ 1.(~l~IU.~:
'll~is is nty ~IrrL•~rali~~n of I)c?micilc ;ut~l Citirtn,hip in thr St:it: oi' I~iorida th;~t i at~t (71in~ this d:t~• in
arc~~rii:~ncr, :in~i in conf~rmity ~vitit Sccticin "~.17, Florid:i Statutcs.
1 was formcrl ~ a Ir+~al msid~nt of ~ G~ `
) r - ~SCa.1Z and 1
(c~~~•) (swt~ )
nsidrd at ~~~~~i . 1lo~vcvcr, l havc chan~cd my domicilc to
( trcrt and T~u~nMr)
and anj and havc bcen a hona ti~ir msid~nt of thc Statc of ~lorida since 6~ day ot'
f/i~ rJ ~m .~r r a, 192_~ , and 1 msidc ~t p •
~ • (Street and Num )
/L ~ ~ r[' Cb J~ ~ CO11111y, Florida,
(CitY)
and this state~ncni is to be iaken as my declaratian of citizcnship, actual l~gal residence and domicile in the State ;
of Florida.
(Inse~i herr any pertin.nl facls, such as sale ot proper!)• or bu~inrss, or relinquishment of employment at former
domicile~ temo~al of tamily to ncw Jomicile, purchase oi hume, rtc.)
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t FURTHL'R CERTIf'Y that 1«•ill rc~ister ai rny local addmss when thc rt•gistration books rcopcn, and ~
comply witi~ all other rcqe~irements of a le~~l resident of this Stat~.
1 rURTH1:R CERTI~Y that 1 ha~•e no intention to rMutn to my former domi.:ile, and I intend to remain in i
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}~lorida, pcrman~ntly: (~''y~
Q'O~-~t.1'z-' ! ~'~~~~f~t~G..
\ (Name) ~
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swor~ •tc~;/d8 s~rb>crin~a nrror. mc thi~ d:~ of
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, A.D. I97?!. j
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~ n Nu(~ry 1'nblit Sfate uf I I.~~,Jr at s;.•
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1?'~,Co~iiiii~.,~ ~~~4~~C~~ircs--~ - 's
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(To Ur c~ecutrJ in duplh:~lr anJ ~~~yiu.d tdrJ ~~ilh l'Ir~k ('itruit Cnurl. and Ju~~la-a~r with TaR Ascr~ax)
~ooK z04 PA~t 2~54
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