HomeMy WebLinkAbout2839 S
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~i~~ ~i~i ii~ ti-r,~~ri~ c~c~u~~i ~r~~~ ntisi s~c,i;. 2348~1
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'l~hi~ i~ n~y ~I.~clar:itic~t~ ~I Ucmticil~ an~i Citirrn~hip in ti~c Stat; ot~ (~loricla tl~at 1 am flin~ lhis day in ~
accardai~rr. :incl in cc~nli~rmity ~vith Scction ~~'~.17, l~lori~l;i St,~tutcs.
1~vas f~nnrrly a Ir~~al resi~irnt of' Q v~ ~ ,~__L~~______ and 1
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resi~lyd at ----~___1 -.}lo~vcvcr, 1 havc chanscd my domicilc to `
(Strr.t anJ Nutnl~•t)
and am and havn c~cn a hona fidr r~siclrnt of thc Statc of I~lorida since U~E day ot
- 1~--~.~, and I rccidc at Q U~ O ?
(Slrect and NumbcY)
P~~~_ ~ G U ~ i~ County, Florida,
(c~ir)
and this statemrnt is to he taken as my declaration of citizenship, actual lrrat residence and domicile in the State
of Florida. :
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(Insrrt herc any pcrtincnt farts, wch at salr ~f property or husiurss, ot relinquishment of employmcnt at former
dumicile, rrmo~al oi ta~nily to ne~v Jomicilr, pu~ch:ue ot Aome, ~tc.)
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~ - CIERK C1RCIttT CObRt
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1 FURTIII:R CERTiFY that 1~ti•ill rcgister at my loral address when the registration books reopen, and ~
comply with all other requirements of a Icgat resident of this State. z
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1 rURT[iER CERTIf
Y tt~at ! ha~~e no intention to relurn to my fonner domicile, and I intend ro.rcmain in '
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~ T f/f/~'C t , .S T L(J G J E , County,
FloriJa, pcrntancntly: <<'`''~
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S~ri~rii~to~t~d.sttHicrih~d h~for~ mc thi, day of
~ ~C~ -c`~ A. D. I 9~~
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Nolary 1'u1:Ga tilat • I I~~i~J~ rt I.~r_.-
A1y ('c?mmi~tiion r~c~~irr~ a-~-~ _/S~/~]`~
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~ ~Tu br c~raulrJ in du~~h.alr ~n.l .a~; inrl fd: J~~illi l'Irrk ('itr~dl C~~url. and ~lupfi. alr ~v~1h Tas Accr~s~K)
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