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HomeMy WebLinkAbout1515 -1 / ~ ~ ~ i+ r. ~ ^ ~~.~'^r~;~~~n c~~ ~~~~~~~c:z~, .~~~:.__~:t;.~.~ a~~ ~rc~ ~r~ii: ~~r,~~r~~ n~i~ c~ou~~i -r,~x nti~i ssc~i:. • 236060 . r-~ ~c~.~ - - _ c~ou~~r~~, ~~t_c~izii~.~: "fhiti is my ~Irrlar;itic,n c~l~ 1)c~miril~• :ui~l Citir~nshi~~ •iit thr Stal: uf (~lori~la lhal ( am Clin;, this day in ,~rrurdanrr.:in~l in cc~nli?rinity ~~~ith S.ctic~n ,"".17, {~lorida Statutrs. ~ 1~~•as formrriy a Ir;:al resi~l~ nt of ,,l~,L~J~r1-~is~- ~~1~- [J/ and 1 ` ~ ~ (CitYl (Slatc) msi~IrJ at ~_.~*,Y_-..~1~~- . Ho~vcv~r, 1 ha~~c rhan?;cd m~~ domicilc to (St~rrl and Numlrrr) and am and ha~•c bc~~~ a hona fidr rrsiclrnt of thc Statc of t~lorida sincc day of ' / / __~~1~ ~ _ , 1 and 1 rcsid~• at ~~d 6 ~~'i~J / 1 ~s-a ~~tc d ,Q (Strret and Numbe~) ~ ~ Q ~c- . , c..S .S' ~~'e~ County, Florida, ~c~i~•~ and U~is statement is to be takcn as my dcclaratian of citizenship, actual Icgal residence and domicile in the State of I~lorida. (Inuri herc any pcttinenl factc, sucl~ as salr of proprrty or buxinccss, or telinquishment of employment at tormer domicile, rrmo~al uf famil~ to ncw domicilr, purchax o( homt, r~c.) l vI~ ~ k 1~,~t~d,~~ /17v,-~a~.~ - ~ ' ~ ~ ~f cr `~c•v ~l ~~r~' Q~ . . r . St~IUC?C ~pUHTy F~A . ROCcr ?p~TRAs G1t~ ' ~ . pFCnk~ y~"a;~CU~T COURt -11 FI FO U A~c 1~1 I! 29 p~ ,lt I . 236Q6o k ~ - . I ~ I ~ 1 FURTHI:R CERTIFY that 1~ti•ill rc~istcr at my loral addr~ss whrn thc mgistration books rcopen, and comply with all othcr requiremcnts of a l~gal resident of this State. " 1 TURTHIiR CI:RTIT'Y tl~at I ha~•e no intcntion to return to my tormer domicile, and I intend to remain in ~ 7, , ~C` ~ ~i ~ 6 ~ , `fl ~~fC' ~ , County, }~lorida;q~ci~i~hcnt!}~: (c~~r) , . , ] ~ - : ~ ~i'~.-~-~~ _ ~ • C~~L' (Name) ~ ~OR~i? - ~ ~ ' ~ .z j ~ ~ (AdJress) = , f ~ S~vorn to and subsrrihr~l h~fur. mr thi, ~y _ d:~y of ? ~ ~ , A.1). 19 ~Y ` ~ - ~ - - - - - Nuuty Pub6. tit uf I I~u~~l~ af 1:~r_•.• ; ~ : ~1y Commi,sion r~{~irrs ~ - -__0__°1-'_ _ 3 (Tu br c~tculrJ ~n dupl~~alr ~n~l un~ in.~l fJrJ ~~iU~ t'Ict{. Ci~ru~l ('uurl. rnJ Juph~•alr ~c~16 Taa A~crstiur) BooK 205 PAGE1525 ~ ; : : ; _ . - - - . ~ v ~ •I I 'r~ Y ~c .F S~ A n'"GG -rGa`"}':!~.x ~y .`~u Y+2`~ei~" '`:3~'"~lL~-r. ~ _ . _