HomeMy WebLinkAbout0034 ?
~ •~r ~
~j,~ r.. ; a ~ ~ ~ : a~:~'-''~ r j ~ ~
?r~ t. ~ r=~ : i Cr~ ? . .r c:,: i t~,. C C.: l'.L t 17
234991
~rc~'~'~ii ti~~,~~~ ~ c~u~!~~~ ~t~,~~ ,~titi~.ti~c~i;.
,Iti - ~~c~~~ - - _ ('(~U~ I~l'. I~ I u?:11~~1:
'I hi~ my ~Ircl:~rati~?n ol~ I~umiril~• an~t ('itirrn•hi~~ ii~ th.• S~:~t: c~f ~lori~la tl~;it I ain fili~t~~ lhia ~lay in
:~rcur~l:ini.•.:~n~f in cc~nlc~rinity ~~~ith S~~rtioi~ ~~~.17, I~lori~l;i St:~tul~s.
,!1 ~
i~vas f~rm~rly .i Ir;~:ii resi~l.•nt ol' -~•-~,2~~~_ v`~~1~_.--------- , l`.'s~.~r, and 1
(Cityl .'~~tr)
~rsi~lyd at ~_.~Q. - - ~,c~ ~G-----L/_~-- . Ho~vrv~r, 1 harc chan~cd my domicile to
(Strrrt anJ Kumlx•r) ~ ~
and am a»d havc bcrn a bona f~l~ r.siclrnt c~f ihc Siatc ol l~lorida sincc i~y day at~
, 19_ 7~ an~t ! rc~i~lr at ~ c~-c-P. (~Gt~-~i
~ (S1rea1 ~nJ Nu~ubc~)
. ~r~r_t _ County, E~lorida,
(c~i~•)
and this statrmc nt is to he takcn as my declar:~tion of citizenship, ~~ctual legal residence and domicile in the State
of ~lorida. '
(lnsrri hera any prrtinrnt faclc, wcl~ a~ wle uf proprrt~~ ur 1+ucinrss, ar relinquishment ot employment aI fotmer
domitilC, remo~al oi lam~ly to new dumicilr, purch~u of hume, rlc.)
~~/~ZL~C y ~ 'LC-I~~~-Gs~f/ ~~-L
i/
%
234991
F lED aNn RECORD[D
S~. LUC~~ i;~UMTr FLA.
ROCER ?;tTRAS
C~EPK ~!-~~UIT COURT
. RECOF~ VF%~~ 1F~
Auc 9 I zs PH 'T~ -
~y~~
~
~
6
~ '
~ -
~
1 FURTIIf:R CERTIFY th:it I~~~ill rc~•istcr at my loral address when the re~istration books reopen, and
comply ~~~ith all other requirements of a Ie~~l rrsident of this State.
1 rURTH1:R Cf:R7'IT'Y tL•at I ha~•e no intentit~n to rcturn to my formcr domicile, and I intend to remain in
~~~t~c-~-' _ _ - , ~t~,l~~t,.~i , County,
Florida, prrman~i~tlr. (c~~r) -
~ ~~?~c~~~Z c,~ 7~a~~
~ p f.,,
~ . , -
~ ~ ; .~1LL ~ t
. . (Name)
~ a o . Q ./~~Pi ~C~.'/LG+- ,
~ , ~ __~~~P
:
w (AdJress)
~ . . . ~ ~~.v `
~ S~vy~ii~t~-;md.~iit~:rihrcl hcf~~r. inr thi. day of
~ ~
`
- - ~~A-I). I9~
~ _ _ _ _ _ 4'
~ Nulat)' PuhG. til~lr u( 1 I.~nJ.~ aI 1.acr
~ .
l~ty Cc?mmis,i~,n r~~~irrs_ ~ .~~-c~ /~7~~----
~
` (Tu br c~acolyd ~n Jupl~~:~lr rnJ un; ~n.~l fdrJ w~lb l7rrA ('~r~'u~l ('~~ur~. rnd Ju~~h.alr ~~~11~ Tax Mcc~~~~~)
R ~4
~OQK PACE
~ - _
_ _ ~ ~ .