HomeMy WebLinkAbout1790 ~l+E..~~.`~.s~C~C~v~ C.. ~ /Z's~ricv G~t~ ~1~t~:.~:i
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~ro ~rii~: s~r;~~ci: n~n c'OUN~r~~ ~r,~x nss~~stioiz,
CUUN'1'Y, I~ LOltll)A:
1'I~is is my dretaration c~f Ucnnicilc anJ Citi-r~n.hip in thr St:~t~ of ~lorida that 1 am Glin~ tltiis day in
accord:~n~r, and' in confonnity with Scction 2'_'? 17, ~lorida Statutrs. `
I~vas forn~crly ~ Irral residrnt ort' fD~E~Tl~/LL~~'~ ,~~'~L/P'~ and I
(citY) (state)
residcd at .~C~YiEI~J ~R/!~~ . lio~vc~er, 1 liavc changcd my domicilc to
(Sl~ctt snd KumMr) ~ .
and am and .have bccn a bana Cdc rrsiclcnt of' thc State of florida since ~z~" day of
~ , 19~~, and 1 residc at 1~~ /3DX~ ~760--7l~ . _
(Stteet and Number)
^~Z Qf~i! ~ ~ - ~ , ~ L i~ ~ County, Florida,
' (air)
and this statement is to be taken as my declaration oP citizensl~ip, actual legal residence and domicile in the State
ot Florida.
~
(Inse~t here any perlin.~l facts, sueh u sale of p~operty cx busincss, o? reli~quishment of employmenl at fo~me~
domicile, ~emoval oi family to new domicilr. Qurchue of home, ele.)
~a' 7-l~ C h~~~ ~ i S ~ h~o L.._
~%362~'2 -
- ST~lUC1E COUNTY ~lA, ,
. ROCER P01TqA8 -
CIERR Ct'tClJIT COURT
~ RECOR~ VE~iiF1ED~~~
' ~ AuG 18 10 2s ~N'11
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I FURTI~ER CE1tT1i=Y tl~at I~~~ill rcgister at my local address when the registration books reopen, and
comply with all othcr requiremcnts of a lcgal resident of this St~te.
I CURTI~I:R CCRTI~Y that I ha~~c no intcntion to mt~~rn to my tormer domicile, and I intend to remain in
p/E.~ c~~ S'T G l~ c' , County,
Florida, pcrn~ancntly: '
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• ~ v G
~-~'s `~C.V' .~a •
~ p~'•:s, ( -
_ ~%°L ~ ~ .~r ~ a~,r ~ ~~o- ~o
- . ' . (AdJress)
. i~ ~ tir ' .
'Sw,or~r' p, .sitbscribrd bcforc mc lhis day of
t~ .
~ ~ A. U. 1 ' .
- G!.c-fG~ C~ ~ -s
Nolatr 1'ul~lir Sl~te f l I.~r~da at 1_at~.r '
~
My Cammis.~ion rx~~irrs a-~~ ~~`/1~~ ~ ~
(Tu 1?e e~eculed in dupliralr and ui~~i~ul f~l.•J ~~ilb l'la~k Circuil Cuurl. anJ Jupiw•a1r with Taa Ma~sw~)
BO~K ~5 Yacf 7
1 t90
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