HomeMy WebLinkAbout1632 ~-~~c~n c~ ~,~Q~~~c~~~ G: : ~t;?~ ~
'1'U'flit: S'I',1'1'l: AI~1) ('OUN'1'1''!'A\ ASSI:StiUIt, .
_CUU\'1'Y, I~LO~~~nn: 236153
1'liis is my ~Irrl:iration of Uomicilc .incl Citii~nxhip in Ih~: St:~t.• of rlorida that 1 am filin~ this da~~ in
accordan~~, ancl in canformity ~vitlt Scctian 2~'3.17, I~lurida Statut~•s.
N~. ~ ~
l was tormcrly a Ir~:il residrnt oi' _ , and 1 ;
(c~~r) (s~~~e~ ;
residcd at . S~ ~ . I~owcvc;r, I lia~~c changed my domicitc to ~
(Slretl aod t~umbrr) ~ '
and am and .liave bcrn , a bona lide n•siclcnt of the State of ~lorida since ~'S day of
/ / 7 . G'~+-~-~e•~,, ~
~'O~- , 19 7~' , and 1 residc at - -
~ • (Street sn~mber) :
'u~e'`.` " . `ce~.`' County, rlorida, :
(acy)
and this statement is to be taken as my dcclaration of citizenst~ip, actual lrgal residence and domicile in the State
ot Florida. ~
.
~
(Insert ht~t any ~+erlin.nl facls, such u sale ot property or Ausiness, or telinquishment of employment at fotmer ?
domicile, ~nnoval of family to ne~v domicilr, purchase of hume, cle.)
~ yt~~ C2.~~~ .c~y~... /1 C-~~ .
,i ~ . /
~ c,~..~f~~- ~ i t<i. fL y,.L-"."-.~,,~
J
_ , ;
. ~
- ~
,
~ . 236153 ~
- .
. ~ y .
- ~T.~~iE D OUNT1fR /l~
RACE~ P~3tTR~s ~ .
~ CLfRK C~~CU~T C4URT
RECOP~ VEFf~IEO~..~.~.t.
A~rc 15 10 22 AH'12 ~
, . -
~
{ • f
i
k
~ . I
{ t
f
e ~
F '
;
~
l FURT}iER CEItTI~Y tliat I~~~ill registcr at my local address when the rcgistration books rcopcn, and
comply with all otlier requirements of a lcg~l resident of ti~is State.
I rURTI~ER CERTIrY ti~at 1 ha~•c no intcntion to rctiirn to my tormcr domicilc, and I intend to rcmain in
- :-~'JC . ~~,~-''~.-t-,~- ,~J
f ' ~-~-c-c~- _
, . , COUrity,
Florida, pcrmancntly: ~~''y~ •
,
~ o
~ ' ,l a,
~ f~ K R e~ T iQ. ~~N~~~ -
~ i Cc~
~
~
~ . (AdJress)
~ . R
~ S~ti~on~ .td.and suUssiibrd bcCorc mc this s~day of ~
~ ~ ~ .
~ ~ A.D. 19 7~% '
~ ~ ~ ~ ~ l~ . ~
~ ~ I~O(sty~l,"nhli~ titrtt uf 1 IuriJ~ al •r t
. ~ • _ _ ' l C.F/LjL
My Commiccion rr~~irrs f ~
. 800K ~Q~ ~ rA~E
(Tu be e+?ecuteJ ie duplN•~~r ynd uii~in~l fA.•J ~~ilh l'1~•tk Caeuil ('nutl, anJ Jupla~atr w•ilh Tai A~arwx~~
~
xi` - - .
~
~ ~