HomeMy WebLinkAbout1692 ~~.e:~~r~~~~~ c~~ ~Q: ~
c~c«~ ~:r~ ~~~~~~i
•ro •ritt: s~r,~~r~. n~i~ c'OUN"l~Y •r,~~ nssi:ssoit, 23618'7
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i~ -_C'UU1!'1'Y, I~LOIZII)A:
17~is is my ~Ircl.~ration of t)c?micilr ancl C'itii~•n,hip in thi: Stat~ of ~loricla that 1 ant Glin~; this day in
accordan~r, ai~d in conformity ~vith Scctian 2'_'2.17, Florida Statutrs. `
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t was formcrly a Irgal residrnt oi' ~-~-.A ~ , ~'~~`--v and 1
~ (CitY) (Statc)
residcd at 7 r~orn^ r.~ • . Ho~vcvcr, I liavc changed my domicilc to
. (Strert snd t~umMr) ~
and am and liave bccn a bana Cdc rrsidcnt oC thc State of florida since ~day of
- , 19_~ and I residc at S/
(Stteet and Nu~nbcY)
,
~~-t ~ ~~c~;t,~ ~ ~ , -s~- ~ u ~ i•- County, Florida,
(c.iy) .
and this statement is to be taken as my declaration of citizensl~ip, actual legal residence and domicile in the State
of Florida.
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(Inscrt here any pettinent facls, such u sale of properly c?r Auciness, or relinquishment of employment at formet
domicile, remoral oi family to ne~v domicilt. purchue of home. elc.)
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CG-..~.~1'/LC, 1~-'~-~-C~ q. _ ~ - -7
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~uc~`~ couN~Y ~i~.
' ^Qy~r ?U1TR~S
i CIE~K C~••':.U~T COURT
i " ~ ~ IIECOR^ : ~ED
i
~ Auc ~5 I 4a PN'~Z
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I FURTHER CERT[I=Y that I~~~ill rcgister at my local address when the ngistration books rcopen, and ~
comply with all otl~er requiremcnts of a legal resident of this State.
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I FURTI~I:R C•RT11=Y tt~at t ha~•e no intention to rct~irn to my former domicile, and I intend to remain in ~
~ ~-L/~~C~ , _-~c~~ ~~[.c~ ~ _ , County,
Florida, pcrmancntly: •
~ PAULINE CA ELL
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~ ,~~~y~~~~N11/Ni,,
`~.~`~G V 1 T C '4~~~ (Namc)
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~ ~ 4~,..~v„M~ °G'-~ S~s^ T ~/--~-cL
ti • i
l . ~G ~ . (AdJress)
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:$yy~ra t. rRlcrl bcforc mc thi~ ~S= day of
. {
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_;j.~C ~ A.I). 19 7~~- ~
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b-~ C.~c.~' G.c'-`"`,.,T .~i¢`'`'`.~ _ ;1
" ~ • ~ o • C ,
My Camnucsion cx~~irrs . ii~~~ .
~ (Tu Ut e~eculed in dupla~~lr ~nJ unrinrl fdrJ ailb l'Ir~k ('ircuil ('nurl. auJ JuplK ale wilh Taa Asaewx) ~
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. ~:`.~'c~'`'`w~.'~ 23- t._.'~.~ ~"i ~-,v.a"~ > .