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HomeMy WebLinkAbout3459 243924 QcC~c'~i'ca~iQil t'i~ ~:~~=Ci~~ w~~ ~::~l~~~S~!'r? l~U Ttll~ STr~Tt: ANU ('UU1~'TY TAX ASSI~SSOR, - ~~~~-~-'u--~ ('OUNTY.I=LORiI)A: This is my ci~rlaratioi~ uf l)omicilr and Citizrnship in thr Statr ~~f Florida ihat 1 am tiling this ~iay in arcc~rciancr, an~l in cunl~urmit~r with Scrticin ,,,.17. Flarida Statutrs. ~ ~ L~ - IY~. l~ti-as lom~rriy a I~ral rrs~~i~nt oi ~.--'~-~it _ I~_~_s_~Ltrt~ . - - and I . .Z~tc•~~.~~ - - - - ~s~ - ~L4~~~~~! ,it ~-`ts-~~rL~~~~~G~ - - _ . Howev~r. 1 have ch;inKed my domicile to (titrrrt rnd itumtxr) ~ ~ :~n~l am :inJ hav~ hr~ ii a bona tidr rrsi~irnt of thc Stat~ ot~ t=lorida since d~y of ` C ~ e-~ e~t a~~ l 9~•~L__ , anil 1 re,id~ at - v~"~~._ ~hc`.~~,o~J ~~-t..P/ _ tcc~t~t1~ ~ (Strret and Numlxr) ~_>~~I • . -u-E-(~C~ ~P~l.~,li _ County. Flonda, ~c~~. ~ _ _ . _ . ;.;~d this statem~nt is to b~ taken as m~~ drelaration uf citirrnship, artual lrgal residence and domirile in the State ~>t 1=loriila. (Imrr. hrrr an> prrUnrnt factc, such :~S ,.ilr ut pruprrty ur hutiiness, ur relinyuisAment uf rmplo>ment at furmrr dunurilr, rrmu~al uf tamih• tu nr~~ Jumicilr. r~~.n:,,t ~r n.~mr. ~1r.1 ~ u, c~c~t ~ . ~ < - ~ 243924 ~ iT~iu°ciE cou~Y Fu . ROCEF POITRAS CLERK ClF.Clt;~ COURT RECORO YER~i1E0~~ ~c f9 2 rrPH'1 i ; ~ ~ ~ t € i f a ~ ~ € ~ ~ ~ ~ ~ I FURTEIER CERTIFY that t will rr~~ist~r at my local addr~ss ~vhen the re~~istration books reopen, and 4 ~um{~ly with all oth~r req!~irem~nts uf a le~al resident of this State. ' ~ S ~ I f=U THE jCERTIFY th.it I ha~~e no int~ntion to return to my forn~er domirilr, and I intend to rrmain in ~ ~ ~l,GL ~l C~OUIIIV. ~ .~-1- - - - • , - - - . - - - ~ E=Roridu:~P~;jfianrntly. ~c•"•~ ~ ~ ~r~~c ~i, Y ~ . ~ . . /~`L~ i~~~- - - - t~ .r • : _ : C . . , . (tiame) ~ ` • - . . , . _ : i : _ . _ ~ , a~ ; . . . . . . ~ \ n _ - - - - - - _ _ - _ - - s ~ . • ~ hA~he~s) . ' . v - ~ - ~ ~ f~C~~~~ci~ i~~C~~i~~~ubs~ribed betorr tne this ~1ay of ; ~ ~3 ~~'a'~."~//•` ~ a, ~ t ~~C !~l' - ~ t~. ~ 1/ : - - f . ~5 ~ ~u-l-c-~ - - - ' - - - Nu~ar ubli. State uf I lorida at Larcr : NOTAR1r pUgLIC, STATE of fIORIDA st U1RGE ~ty ('ommission c~~ires MY CQMbA1SSipN EXRii2fSlAM.--}~„ 1975 - ~ ~~D 1NRU GENERAL INSURANCE U~.uE:t?YRITERS ` A (Tu bc r~rcutrJ in Juplicatr and uri~,inal (ilyd ~vi1h Clrrk ('ircuit Cuurt. and dupticatr ~+ith Tax Assessot) °cRK 2~9 454 . - ~ ~A~ , _ . _ ~ . _ ~ . ..~::R~