HomeMy WebLinkAbout1802 ~l?~~ ~~'c'~, CE~I~ G1 ~'QiZ~C«° c i i~ ~~~z~ :i
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'I'O'fitl: S'I'A'l'l: \I)C'OUN'1'1''1'~1\ ASSI:SSUIt,
uP_C'UU\'1'Y, I~LUltll)A:
~..~~s~~~-----
'I~tiis is n~y clccl:~ration of Uomicilc aiiJ ('itiirnxhip in Ihc Stat~ of ~lorida that 1 am Cling this day in
accordancr, .ind in conl'onnity ~vith Scction 2"_'3.17, ~lorid:i Statutrs. `
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I~vas formcrly a Icgal residrnt of P~ . v ~ and 1
~ (Ci y) (SW )
residcd at .«~~G-,.~
~G~~~~~ . Howcvcr, I I~avc changcd tny domicilc to
(Stretl snd Numbrt)
and am and .l~ave Uccn a bona fidc nsid~nt oi thc State of Florida since day of
19__:Lr~ and 1 residc at ~ ~ ~ ~G~G~ ~ ~ ~`~C ~
(Slrett snd Number)
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~~~j El`C ~ ~ U!"r ~~Cc..- . ~ County, ~lorida,
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and this statement is to be taken as my declaration oP citizenship, actual lcgal residence and domicile in the State
of Florida.
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(lnsett nerc aoy {+ettincnl focls, such as sale ai property cx busincss, or relinquisAmcnt oi employment at forme~
domicJe. removal of family to ne~v domicile, purchau of homc. rtc.)
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. s~`LUC E COUNTY F~ -
' ~ " ~ : CLERKCCR ?OtTRAS
J~r ~ RECOP.D yc CUIT COURt cA~'`'
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_ 18 09 ~'T1
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1 FURTIIER CEltT[i=Y tl~at I~?•ill rcgister at my local address when the rcgistration books rcopen, and
comply with all otiier requirements of a legal resident of this State.
I FURT1iER CL• R Y that ! ha~•e no intention to retUrn to my former don ' ile, and I intend to remain in
~ .
`f . - , County,
Florida~ pcrmancntly: '
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- ' (Name) .
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• (AdJress) .
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Sworn to and stitkc,~#h~d brforc mc this day of
~ A.U. 19 '
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f'3.~~ _4.~~ ~i g ~ A
rt ~~y ~w~~r. s~~« <?r ~ u~~~ i.~~?:. BUJK ~V~ PACE l~z
My Con~mic~ion rx~~irrs_~ ~ 7
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lTu Ix circutrJ in duplic~~r ~~~J ui~rin~l (drJ ~~ith l'Ir~k ('ircuil Courl. anJ JupIN•atr wilh Ta~ Aswaux) ~
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