HomeMy WebLinkAbout1971 ~'~~~;::'c~~~tL3~ Gi ~ t~`~:~::~ ~i ~ ~i~~ ~ : ~i~3 ~ /
~,-ii~: s~r,~~ci~ n.i~ cou~~,~,~ ~r,,. nssi:stic~r, ~2;36,4i9
c~.~_`:_~~! C~r~ C'UU\'1'Y, I~1.OItll),1:
11iis is my ~Irrl:iratiun c~f Uon~icilr :uxl Citir~n.hip in thr Stat: ~r r•i~~~a:, thal l am (ilin~ this day in
accordancr~ ai~d in canlormity ~vith Scctioi~ ~?'.17, I~lurida Si:~tutrs. `
1~vas formcrly ~ Irg:~l resiclcnt of f~ ~~s f C o~~ 6, A , ~-~C . and 1
~c~~r) (sw~e~
residcd at fl ~~.r~' s?~~~~ F' ~ , Iio~vcvcr, 1 ha~~c changcd my domicilc to
(Sirercl a~~d NumMr)
and am and l~ave bcrn a bo~ia fidc r~sidcnt of the State of rlorida since ~G' day of
~~~lL,~ ~ , 19~~ and l residc at ~G D~,? ~ c~s ~~s: N~~
(Strcet and Nu:nber)
,J~: ~P~' ~ ~ , U e ~ ~ ~ County, Florida,
(c~~r)
and tl~is statemcnt is to be taken as my declaration oP citizensl~ip, actual legal resiclence and domicile in the State
~ of Florida.
.
(Insert hete any {xrtiornt facts, such as salr ot pr~perly or bu~ioess, or relioquishment of employment at fotme~
domicile. temoval oi family ~o ne~v domicilr, pu~cfiase of home, c~c_) ~
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~ ~ F~LEO AND ~ECOROEO
~ S . WC~C^CIUNTY FlA- t
. RoGE ~ "3;T COURj ~
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I FURTIICR CE1tT[~Y tl~at I~~•ill rcrister at my local address whrn the rc~istration books rcopcn, and
comply with all othcr requirements of a l~~al resident of tl~is State.
I rURTHER CERTIT'Y tt~at 1 l~a~•c no intcntion to rcturn to my tormcr domicilc, and I intend to rcmain in
~7.` ,~-~~iiPC~ ~~o~-~~,Q , . ~7'l u c ~ e , County,
Florida, pcrmancntly: (c''r~ ~o bbj/ 1/ - ~~e i 5 ~ c?Z. ~
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~i . ' (Name) ~
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. (AdJrefs)
Sworn to :tnd ~ubs:~rihcd hcforc mc this clay of
- A.D. 191
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Nolary ~blir til Ir uf 1 t.~nJa aI (_ar~.r
~~--,~3 ~ooK205 ~?~E197i . :
A~1y Commi~.~ion ~~x~,irrs _
(Tu br raecutrJ in dupli.~le auJ un+:in~l fd.•J ~~ilh l'Ir~k Citcuil ('uutl. anJ Jupla•a1r wilh Taa A~srwu)
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