HomeMy WebLinkAbout1575 ~.I`r~.?~~ili C..i\~V~ f V\ 6+ V: i ~:Vi:v C.:~ i~A v.~1l.:t+Vf ?~ri Ill? ~
.•ro ~riu: ti~r. ~r~: n~i~ c•av~~~~~• ~r,~x nssi:s~c~r, 2~6099
~.J~`~ t«-~~.__.___ C'UU\"I~Y, 1=1.UItll)A:
l~l~is i~ my ~I~~cl:irc~tion ~~f Uamirilr .in~l C'itirrn.hip iii Ihr St:~t~~ ~f (~lorida th;tt 1 am fi]ing this day in
accordanrr, :ind i~~ canformity ~~~ith Scctioii ~?'.17~ Florida St:itutrs. `
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1~vas fvrmcrly a I~ral residrnt oi' ~ t'' , and 1'
/ ,~j ~ ~ (c~~r~ (s~ac~~-
residrd at C~...~<-~ 1//~-(,~t~•~ . Howcvcr~ 1 1?avc changcd my domicilc to
(Strert and I~umbcr)
and am ~d have bccn a bona. tidc rrsidcnt of the State of
~lorida since day ot'
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, 19~ and 1 residc at p ~ . ~ ~ ~ - . _
~ ~ ~ , (SlreN and Nu~nber)
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~ 9't- -C~Q , ~ ~ C
t County, I=lorida,
(c~~y) . ~
and tl~is statemcnt is to be taken as my declaration of citizensl~ip, actual Irgal residence and domicile in the State
of Florida.
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(Inserl here any ~+ertincnl facls, such as sale of properly or Auciness, or telinquishment of employment al fotme~
domicJe. removal of family to ne~v domicile~ purchase of hume, rlc.)
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- 236099
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~ 1 FURTIIER CERTIrY that I n•ill rcgister at my local address whcn the rcgistration books rcopcn, and
cotnply with aU otl~cr requirements of a leg~l resident of this St~te.
I FURTHFiR CERTIFY at I~ha~c no intcntion to rcturn to my formcr domicilc, and I intend to rcmain in
~ -~~1~~- , . ~ , County,
Florida, pcrmancntly: (c~~r) ~ •
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p • ~ (Name) :
~ ' ~ . S G~ i~~~ _y ~i '"j ~9-t_~ ~.~.C~~.~~-
: ~ (Address)
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S~vonrdoran~~s?it~ccribrd bcfor.• mr this~y day of
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Nolt 1'ublit Sl~te i I..nJ~ al I.aiKa.-- O R ~(jC~ .
~ My Crnnmission rx~~irrs - ~1~- ~O~K ~?vV YAGE~575 -
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(Tu !?r e~rcu~rd io Ju~~li.a~r anJ un~inrl fdrJ ailh (1r~k ('irruit Coutl. ~uJ Jupl~ra~r ~.~i~h Taa A+KCSOr)
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