HomeMy WebLinkAbout2873 ~~~~^r~~~~~ Q~ ~,o~~;~~~~ G~~ ~.~t~i~~~:
2348'72
~ro 'ri ~r: s•r,~~ri~ u c~au~•~ ~r,~x nssi ssc~it.
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"1'his i~ m~~ d~~claratic~n uf Uc~i~ticil~ :~n~l <'iliirn:hi~~ in thr Stat: of rlori~l;? thal 1 ant tilinr tl~is day in
ac~ordancc, :in~l in coni'rn~mity ~vitlt Srctic~i~ ~~'_.17, t~lorida Stalutrs.
E/~ia6~ y!
! was fonnrrly a Ir~al msid •nt of , N~f and 1 ~
SSlo ~~c~i r»c~~q/--ST(c~~r) (s~atc)
residrd at ~ . Ho~vcver, I havc changed my domicilc to
(Strrrt and I~umMr)
and am and havc bccn a bona ficic r~~sidrnt of thc Statc of ~lorida since day o1'
~u ly . , 19_ 7~- , and I residc at , y~'/ FR/5~ -/n NR PL
(Sltret anJ Numbe~)
~ J'- erc ~ , 'i~~-u-c-~-v County, Florida,
(c~~y~ ~
and this statcmcnt is to be taken as my declaration af citizenship, acfual l~gal residence and domicile in the State
of Florida. i
(Inseri ~erc any pctlinenl facls, iuth az s~lr of property or businrss, or relinquishmcnt of cmployment at fotmet
domicile. remo~al ot (amily to ncw domicilr, purchasc ot homt, e1cJ
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2348'~2 .
f LEO ANO RECOR E~
a~ 111CIE COUMTY ~~A.
C~ERcC RCUlT COURT
RECORp ~ERIFIEO...,~,~
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~ I FURT}IER CERTIPY tl~~t 1 will rcgister at my local address when the registration books reopcn, and ~
comply with all othcr requirements of a Ie;~al resident of this State. ~
I T'URTHI:R CERTIFY that I ha~•c no intcntion to rcturn to my tormcr domicile, and 1 intcnd to rcmain in
~ j P r c e , ;~-~-~--c-c- , County,
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