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'I'O 'fl ll: ti'1'A'1'I: AI~1) C'OUN'1~1' 'I'~~X ASSI:SSOIZ,
_~!^~'«-~CUUN'1'Y, I~LOIZII)A:
'll~is is my drelaration af Uc~miciir ,~nJ Citi•rrnxhip in thr Stat~ of rlarida that 1 am Cling ihis day in
accordancc, ,uid in canforntity ~~-ith Scction 2?3.17, Clorida Statutrs. `
I was formcrly a Ir~al residcnt of ~R Q~ 5 or? - , Ne ~f o~? If , and 1
(Cilyl (S ate)
tcsidcd at `'E ~ A~ R i S o N R?(' . Ho~vcver, 1 havc chaiigcd my domicilc to
(Slratiel snd 1~umbrr)
and am and have bccn , a bona fidc rcsidcnt of thc State of rlorida since A v~• I`~ day ot
, 19 7
2 and I resictc at ~°2 l~L 'q G~ Tq CO U I? %
~ 0 I ? ~ V C ~ ~ S~' • ~l CG I ~ umber)
. County, Florida,
(c~ir)
and this statement is to be taken as my declaration of citizensl~ip, actual legal residence and domicile in the State
ot Florida.
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(Inuri here a~y pertin.nl facts, such as sale of property ~+r bucincss, ot telinquishment of employment :t fotmet
domicile. temoval of family to ne~v domicilr, pu~chase of home, c~e.)
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~L l1~CIE G(1UMTY fLA. .
. ROCER POIT!IA~
CIERX C~~GU1T COURT a~~' -
RECO4R VER~~~ED....~...... ~ ,G '
pucx5 10 39 AH'71
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~ 1 FURTfiER CE1tT11=Y tl~at [~ti•il! register at my local address when the rcgistration books rcopcn, and
comply with all otlier requirements of a Ier~l resident of tl~is St~te.
t I=URTI~ER C~R 1~ tt~at I ha~•c no intcntion to rct~~rn to my tormcr domicilc, and I intend to rcmain in
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~`T C . - c`~ ~u~ , County,
Florida, pcrmancnUy: VITO PALAZZOLO ~
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~ Sworn to and subscrib~d bcforc mc this.-z`~? day of ~
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~ - --1~~ ~r~.~ A.I). 19?~~ ~ -
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Nolaty 1'ublic Slrle uf I I~~nJa ~I I.rr~;r ~ G; • -
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h1y ConinucSion ~ x~~irrs : 7 ~ ,~~,;~K~ : ~
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(Tu Ix rxeculed io doplir•rlr anJ u~~Rinal (drJ aith ('k•~k CirE~iDs~intl. a~J Juplyd{~w~~ TaR A«ctuK)
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