HomeMy WebLinkAbout2870 ~~c~~r~~E~r~ ~o:~~~ic~~~ `
~ro ~ri ii: ~~r.~-ri~. n~u c'UU~7 Y 'i~~~x ntisi .su~it, ~ 234869 - _
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'1'liis is my ~Ircl;u-atic~n ~~I' l)omicil~• an~f Citii~n.hip iii thr Sl;~t: c~f I~loricla that 1 am iilin~ this clay in
acc~~rclanrr. :~nci in confi~rmity ~vith Srction l 7, l~lurid:~ St:itutrs.
1 was formrrly a Irral re~idrnt c~f - , ~ f and 1 i
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residrd at _-f~ls` . Ho~vcvcr, 1 havc chan~;ed rny donticilc to
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a~id am and havc Ucrn a hana fidr r~sidrnt of thc Statc of I~lorida since day ot'
, 1 and 1 residc at ~y~~ . -
` - y~ C7 ~ trect and Nwnbet)
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~ ~ County, Florida,
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and this slatemrnt is ta be taken as my declaration af ciiizenship, actual legal residence and domicile in the State
ot I~l~rida. -
(Insrrt hcrc any prrtincnt facts, such as sal~ of propcrty or businrss, or rclinqu'uhmcnt ot employmrnt at iormer
domicile, remo~al uf fainily to ne~v domicilr, purch-rx ot Aome, rtt.)
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f LEO AND RECOROEp
~UCIE COUMt~ flA.
CLERKCCIRCUIT C011Rt
RECORO~VERlFIED.~,,,~,~`
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A+~ 8 10 07 AN'~2 ~
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I FURT~iER CERTI~Y that I~vill rcgister at my local addmss when the rrgistration books reopen, and ~
comply with aU oti~rr rrquirements of a le~al resident of ihis State. ~
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I rURTHI:R CERTIF'Y tL•at 1 ha~•e no intention to return to my former domicile, and I intend to remain in
T~ ~--E~ _ , ~ , County, 3
Florida, pcrmanrntiy: cc~~r~ ~
: v~::. Jo~~C%,. ~ i
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~`~W~2r•t~ to ap~J'~iYNcrihcJ h~forc mr thi, day of
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A.I). 19~~ . '
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oqry Publit titrt I I.~nJ~ al 1.nir
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h1y Commi~.tiion r~~~irrs--
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~To ( r~eculed in duph~alr anJ ur~~•iu.d !d.•J ~~i11~ l'Irtk ('ircuil CuuN. anJ Jupl~.ate w•ilh Tax Ascrcc~K)
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