HomeMy WebLinkAbout4250 Declaration of Domicile and Citizenship
TO TH : STAT ~ nv ('vUN'1'1' 'l~A\ ASSt SSOR. 244439
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~Ttiis is my ~Irriaratiun ot~ Domicilr c~n~l Citiz~nshi~~ in thr State ot~ Florida lhat l am iiling this day in
arcurdanrr, an~1 in conlormity with S~ction ,,,.17. FIori~1a Statut~s.
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1 was forn~crly a k~al rrsiJ~nt ~~1 ~i~.~~~'~%L~-- r~ and 1
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Ir~tY ) (S~~te)
r~sided at ~~.~y h!' N S C~ . . Howrver. I have changed my domicile to
1Str rt rnJ Nu~rr1 ~
and ani an~ havr hr~ n a bona tidr r~siJ~ nt ot~ thr Statc ui Florida sinc~ -_G_~ 2_ ~ N dday ot
_~t1 c . I q 7'~! and 1 rrsi~ir al ~~_y_ ~~~~4~! __L/~ t~clR- in .
Streri and Numbrr) n0 ~L,
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_ _~.-_t~'~~--~ _ ~I_, c«`~--------_ County. Florid~.
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and this statemrnt is to br taken as my drrlaration o!' ~itirenship, actual l~gal msidence and domicile in the St~te
ot~ Florida.
(Insrr. hrrc anY prrlinrM faitc, ~urh as +:~Ir ot proprrty ur ~u~mrs~, ur rrhnquunmrui ui rmpiu>mrui ai iunuc. -
dumicile, rcmu~a! ~~f fam~h tu nr~c d~~mirilr, purrhasr uf humr, rlr.)
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~ t FURTHER CERTIFI' that I will rr,~ist~r at m~~ loral address «•h~n the r~gistration hooks rcopen, and
~ comply wiih a!1 othrr requircmeijts c~f a I~,~al r~sid~nt of this Stat~.
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~ I FURT~iER C'I:RTIFI' it I ha~r n~~ intrntic~n to rrtum to m~• fornier domicile, and 1 intcnd to remain in
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r /`--~~it-t . ~~~-~sL----__ _ . County.
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- Sv~~c'ir~Lt[l.:ind ~nbs~~ibed b~turc• m~ thi~ ~la)~ oi
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