HomeMy WebLinkAbout1713 ~'~cE~~ ~i ~CJ~ i
tsC~~~ c ~t
•ro •ritr: s~r:~~ci. nni~ couN~r~~ ~r,~a nssi:s~oit, 236203
~ CUU\'I~Y, I~LOIZII)A:
11~is is my ~Irrlar:ition of Uomirilr .i~id C'itir~•nship in U~~~ Stat~~ of t~lorida that 1 am filing ihis day in
accord;m~r, and in conformity ~vith Scrtion 233.17, I~lorida Statut~•s. `
~ • -y, .
1~vas tormcrly a I~gal residrnt of - , / l' G and 1
~ c~~r~ ~s~~~~~ -
residcJ at L~f Z- ~ . Howcvcr, 1 l~avc cliangid my domicilc to
(Streel and NumMr)
and am and have bcrn a bona fide residcnt of the State of ~lorida since 1~ day of
, 19~~, and I resiclc at -33~ ~ , '
reel and Numbe~)
~i9-~~ U~c-~M-~-~ , County, Florida,
(c~~r)
and this statemcnt is to be taken as my declaration of citizensliip, actual legal residence and domicile in the State
of Florida.
,
(lnsert hete any ~+erlinent facls, such as sale of propertg ~x huxiness, or relinquishment ot employment at fotmer -
domicile, removal of tamily to new domicilr. purchue of Aome, rlt.) I~'<~ ~
~ o~ ~
~ ~ ~
. ~ .
~ , FttEC ANO RF~d~p~
. ST ~~C?E COUHTI' F[~
~LE
~~r ~'tRAS ~
. ~ECaa ~~~:~urT cOttRT '
. ~ v":=~~~~jx c~c~?a
~ - = ~ 15 2 v~ PH '11
- 236203 :
j
~ ' . f
~
\ 2
'
~
~
{ -
P
~ • '
~ r • ~
I
~
` ~ ~ 1
• 1 FURT1iGR CEItTIrY tliat t~ register at my local address whrn the rcgistration books rcopcn, and
comply with all other requiremcnts of a lcg~l resident oC this St~te.
1 FURTHI:R CCRTII=Y that 1 ha~•e no intention to rMi~rn to my formcr domicile, and I intend to remain in ~
. ;
. , . ~ ^ , County, ~
Florida, pcrmancntly: (c''r) ~d s t p h F- G. w~.if ~ve y •
~~~KNNI'~rti~ .
e ~ ?~,y^ %I~.
~ ~ ~ i • ti `a ~if. ~ ~ ~
S '~~~~M~N ~f . /y
~ • ~'a 4'~{,~ :i \•`ifM~' . ~
'
~ ',.•,~r ~~333 ;
, ; • i O~~s~~~Y~J
° ~ J~ess) 2
o ~ ~Gd G ~-~'C-t- 7~
. ' • - _ e°° ~ _~r.
~ S~vor~i'to,~'a~'~lbscrih~d hcfore i»c tl~is ~
S day of ' ~ ~
- . :
.:a.c+',, 'i,\~`` ' . f
.;1~: A.U. 19~1!" ~
' {
- ~e.'!ir !/1 .s
Nots~Y 'ublic r~e of 1 lund~ ~I I.ar~;r ~
~ / .y
My Commic~ion rx{~irrs 1 / ~ ~
~ lTv Ix e~ecutrJ in duplica~r anJ ~~n4io~1 fi1rJ ~~ilh ('Ic~k fircuil ('uurl. anJ Jupliralr wilh Taa A~erwK)
aoox205 PA~17~3
_ : - - - ,,Y.
. ~~t : ~ _ _ . _ ,