HomeMy WebLinkAbout1611 VV~~~i~~~Vii ~Vt..~V~iV C.+.i~ ~<<.a[.~~~ r~t~~~ ~i
~~o •riu: s~r,~~c ~ n~u c•outv~i~~~ •r,~x nssi:ssoit, 236134
~
_ - _coun~r~~, i~LUltll)A: .
1'his is n~y drel:~ration af Uamiciic t~nd Giiir~•~~xl~ip in Ihi~ Stat~• of f
laricla tl~at ! ant Clin~ this d:ry in
accordancr, :i~~d in conforniity ~vitli Scction 2"'?.17, flurid:i Stc~tutrs. `
r-
1 was fonncrly a Irral residrnt of ~~`~-o n ' , ~o w~ and I
~ (citr) _ (state) r
residcd at ( . 1lo~vcvcr, I I~a~~c changcd tny domicilc to
(Strctiet and humbr~)
and am and .have bccn a bona fidc n,~sidcnt of Uic State of ~lorida sinc 2`~ •day of
~~t~ c.~.6~ t~ , 19_.2~., and I residc :?t ~ ~ . ~ ~ , i
` (Slreet snd Numbet)
. ~ e Y'c ~r _ . 5--~ . ~ u ~ , - County, Florida,
cair)
and this stat~ment is to bc takcn as my dcclaration of citizenship, actual lrgal residcncc and domicilc in the State
of Florida.
~
(lnseri here any ~+crlincnl facls, sueh u sale af property cx buciness, or relioquishmcnt of employment at fwmet
domicile. removal of family to new domirile. purchase of home, ele.)
~
L ; ~u / -~~5~ _ . .
GG~ u~e / ~ o I~ ~-e ~pirs~ ,
. T7' /1~ -
Q ~ ~s ~~u> , v~ ~ ~~i's-~~-j
~
. 'a ~P ~ ~ ~ ~ ~-e -~-~rs
~ . -
~fo~4~a ~~c~R~~o
sT wc,F cauwn?
CL RKCL' ~ CUIT C URT
' ~ RECORD VEa~~~ ~ ~
ED ~
i
~ ~ A~ 2S • 9 43 AN '7Z
~ . _
~ - 236134 .
l FURT}IER CERTITY tl~at I~vill register at rrty local address whrn the rcgistration books rcopen, and
comply with all otlier requirements of a Iegal resident of this State.
I FURTHER CERTII=Y that I ha~c no intcntion to rct~urn to my tormcr domicile, and I intend to remain in
~ c r
_ ~ ~ e r c_ P~ ~ u c ~-e , County,
Fiorida, pcrmancntly: ~ •
•
~ , ~at~SC~y - . •
~ , - ' (Nimt) , -
~ •T ^lecVi. ~ ~ ~
~ ' a - 7
e
~ (AdJress) /
, i i j ' ~ ~
>
Sworn to_~fid:st~scribrd bcfo~c mc this day of
_ J . . A.D. 19~L ~
~ `1%~~~/ ; ~ .t
~ Nolatr 1 ~c SI~I uf I lund~ al I.ar}r ; .
~ ~ R 205 P~~E 1611
My Commission rx~~irrs_ /G- 3 -BOOK .
(To Ur eteculyd in dupliralr anJ ~n~~ioal fdrJ ailh ('Irtk Cutui! Coutl. anJ Juptw•ate wilh Tax A~arwit)
- _ ~r cr'w-~~`~
-'<< . . _ _ _ _