HomeMy WebLinkAbout1792 ~~.~~~~'c'~. c.E~11 C~1 ~O~"i~is~~:~ c;~~ ~e ~i~ ~
To •riit: s•c.~~r~~ nnu c~outv•r~~ •r,~x nssi.ssoit, 2362~'4
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_ _CUU1'I'Y, I~LUltll)A:
1'liis is my ~lrrlaration of Uomicilc and C'iti•r.~nship in thc Stat. of florida that 1 am filin~ this day in
accordcu~cr, ,ind in conformily ~vith Scction 2"_'2.17, rlorida Statutrs. `
I~vas formcrly a Ir~al residrnt of 1~-~•Q~ ~ and 1
(City) ~ (Slate)
residcd at .~~o~vcver, I liavc changcd my domicilc to
~ (st tet and brr) ~ , ~
and am and .have bcrn , a bona fidc rrsidcnt of the State of Clorida since ? day of
191~ and I residc at ~~L?.~~ .
~ (Stteel snd Numbet)
~ ~ , - County, Florida,
(ta~r) ,
and this statement is to be tal:en as my declaration of citizensliip, actual legal residence and domicile in the State
of Florida.
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(lniert hcte any {+crtine~l facts, such u sale of propertY o? buciness, ot relinquishment ef employmer+t st torme~
domicJe. temoral oi fao~ily to ncw domicile. purchue of hom~. ctc.)
,/~~-~.~-c-e~~ r7J cJ8-i.~s~..sL. - /S ~ 1 ~ .
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~uciE co~~~Y ~
• • aoCE~ Po~t~t~~
• . ~ ~~~Rx c3RCV~1 C4ult~
. RECOA'3 YE°SFtEO
~ AflC Z~ ~0 34 ~H'~ Z .
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I FURTIiER CEItTI1=Y that I~~ iU rcgistcr at my local address whcn the registration books rcopcn, and
comply with all other requirements of a lcgal resident of this State.
I FURTH~R CCRTIFY tliat I ha~c no intcntion to rcti~rn to my formcr domicilc, and I intend to rcmain in
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c~~(Y~~-~.~ , . c~~-~--~-~-e-- , CountY,
Tlorida, pcr~p~:;tly: (c~~r) -
y t ~ ~ .PAT BI,EDSOE
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zc , J ~,v~.
~ r ~ _ G~ ~ i (Name) .
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s ? i • ~ ~ ~ ~ ~ v ~ / {T ~C~~1. ~~-e~ f~
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_ ~ - ~ ` ~ ~ . (AdJress) .~J ~L-5~
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S~voi'n,4d~~
Fu~b c~~~ bcforc mc this ' day of
' A.U. 19 ~ ~ ~ - • ~
~ ~ s
- -
C.p.u-r~c ,~:..u,~,:.~' . ° ' ` ~ _ .
My Conunic~ion rr~~irrs .
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(Tu Ix ea~culrJ in dupl'a~~r anJ u~i~ in~l (8~•J ~~ilh ('le~k Cucuil Cout1. aoJ Juplw•alc wilh Taa As~esseK)
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