HomeMy WebLinkAbout2884 t~~~~~~ ~~:~~r~ c~z ~:~o~~~=c~~~ ~r~ <E~ '
~
234881
~ro ~riii: sr.~~i~i: n~u c~ov~~r~~ •I~A\ i1SSl.S1OI~.
.
~.Qu~L~_- ..'l,cs--~`/ % ('UU\'1'1'. I~ l.Oltl I):1:
i
"Il~is i. m}~ ~lrcl:iration c~f I~c~micilc an~l ('itir~n.l~i~~ in thr Stat: of (~loricla that I.im filim, this ~lay in
arcordanrr, anci in ~onfc?rmity ~vith Scctioii ~".17, I~lori~ia Statutrs.
I~vas furmcrly a I~~al residrni of iG , :tt~. _ and 1
(c~~r) (swc~~
residrJ at _1_~...2t__'1~~~~_~ Ilowcver, I ha~~c chan ~cd iny domicilc to
(Strrr! anJ [~urnM•r)
1v~
and am and have bccn a hana fidr residcnt of tlic St~tc oi' ~lorida since day ot'
_ ~ ~ , 19__'_`/_~ ancl 1 residc at ~~L ~~L ~--~-Q-~'
(Slreet and Numbcr)
, . ./--u-c ~ p- County, Florida,
(citY)
and this statemrnt is to be taken as my declaration of citizenship, actual lrgal residence and domicile in the State
of 1=lorida.
(Insrri herc any prrlinrnf f~cts, such u sale of pro{~rrly c.r Aucinru, or relinquishment ot employment al former
dumicile. remo~al of family [o nr.v domicilc, purchase of Aome, rtc.)
C~-- ~G-L~-~Lvit . ~~/LI~LCsGL! ~C/ ~.!/7Z, ~ '
234881
=T
LUC E COUNIY FtA~.
. Ct,ERK C~.CUIT COURT
. RECORQ VCF ~~~ED
_ , ~ 8 1~ 14~''Z :
;
j
f
f
~
! '
~
s
1 FURTHER CERTIl=Y that 1~~•ill register at my local address whrn the registration books reopen, and
comply with all other rcquirements of a Ie~a! resident ot this State.
1 T'URTHER CERTIfY tf~at 1 have no intention to return to my tormer domicile, and I intend to remain in
~ y~~Gr_~. e.- ~d~ 7~c~~ p , CountY,
Floric~~,..pt.rma~icntly: cc~~r~
h 1 I•
. \ ,~I•~/ ^ ~
~ / . 3I
° - . . ? ~ , J ~
~ _ • " (Name) i
~ . ~ - t
~ ~ . ~ _ ~ ~ ~ ~!/i_~~C-~t _ 1/1~L,C-~
~ . , - ~ ~ (AdJrcis) ~
` /r . •
~ ' ~ . ` ~
gtia~~~~~tc~~cqti~'seibsrrihrd brfor. mc thi~ day of }
~ • . ~
~ ~ - A.D. 19~~i :
~ ~ _ , i
& - Z
~ N~rtaty Pulrlic tilrlr uf i In11JJ Jl I.aI.'~'
~ ~
h1y Conuni~.tiion rx~~irrs_ ' a-~u~`~'~----~~--
/ O
(To Irr c~tculyd in Jupfic~lr ~n.l .~ri~•inrl hlrJ ~~i1h (1rtA Ci~cuil C~~url. aoJ Juplira~r ~.i1h Tax A~crw~r)
~ ~K~4 ~A~t~2883
Y~,~- ~ - ` `;~4~~ ~ ~ _
~ k ; _ ~
~ ~ r. ~
, . _ . _ _ _