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HomeMy WebLinkAbout4677 I/ Declaration of Domicile and Citizenship 7~U "I'Ht~ ST Tt: .~\t) ('UU\'I1' "1~:~\ ASSI SSOtt. . ~i~c~ ~ c~ ~~~t~: %~%•~~~'718 V~,~ _ (()U\ 1 Y. 1 L It Thi, ix m~~ ~Irrlarali~+ii uf Uomirilr ai~~l ('iti~rn;hiE~ in tii~ Stair ~~i~ (=1ori~la that 1.im iilin~ ihis ~1:~y in :u~urcl:u~r.•, an~1 in c~~nli~rmit~ ~ti~ith S~~ti~~n 17. Fluri~la Statut~,. I~~~as Cc~rmrrly a Ir,~al r«i~trnt ut /C//`/ S% D/~/ . Nrl-v ,2/~ and 1 1(ltyl (Statr) r~si~lc~l at 9 O 7'v 3 i3 y S T~?t~ j . H~?wcvrr. 1 have chan~c~i m~~ domicik to ISircc[ auJ Kumhrrl 7 an~i am .ind havc h«•~~ a hc~n~ ti~ir r~,i~lrni ul~ th~ Stat< <~1~ I~lorida sinc~ day ol t7t ~tMi3t~.. ~q 7Z. :ui~t I rr.i~i~• ac i2~v svvTN ~_3_T-~ sT~2c~ T------ . . _ _ _ . (Surrt and Numbrr) _ _ . _ r" T ~ t'YZ ~ C ~T, L-1.~c i t - - - - . - ('ounty. Florid.+, 'l,,?. ? . and this stc~trm~nt is tu h~ t:ihrn a~ m~~ ~t«larc~liun ~~t ~itiirnshir, artual Irgal residenre aiid domicil~ in the Statr of Florida. ~1nur. hrrc ~n> prrun~nt fach. ,u.h a, ti.dr ~d ptnprrty or hwmr~c. ur rrGnyuuhmrnt of rmplu~'mrnt at furmrr du~ni.ilr_ rrm~.~al ~~f iauiil>' tu nr~+ ~I~~mirJe. purcha~r n( h~~mr, rtc.l C~TNL72i~~t T KR~C iV f}, ~2 r c. N A~Z !`'1. .i i2 o u~o ~t~~ ~~aE cour Y ~~x ~ ~cu T ccu~ -c ~E~oR~ vcP.~F~fe ~ l 11 ~ ~N'13 24~'~'71~3 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I FURTHI:IZ CERTIF=I' that I~vill r~~~i~t~r ac m~ lu~al a~lclress ~~h~n th. rc;~istr:ition hooks reo~,~n. and ~ rom{~ly ~vith all otl~~r r«~iiir~mrnt: r.t : Ic~~al r«idrnt c,t- thi; Si~t~. ~ 1 FURTNt~.R = TI(~l' that I t~:~~~ nu int~nticm t~~ r~turn to my turm~r dom' •~Ir. an~l I intrnd tc~ r~nt.iin in ~ ~ ~ ' ~t c-_c_.-~ . ('ount~•. ~ - • _ ~ FlOfll~;l, j)~i111:It1tIlII\". It 1t~ i ~ ~ . ~ r -y~,~ - / ~R /~i Itiemr) ~y~ o ~6~ / 3 , • ..1. ,.*c , , ~ :~a.i<<<,? _ ~ ,n~ F-' . . . ~ ; ~ . . -'S~~- pi~in..ind ~uFi.~~ihea hrti,e~ m~ thi. J:i~ c~t ~ ~ ~ ~ U. 1 ~ ~t~ ~ _ ~ ~i: % . c' =s ; ~~J~~ C r~== . : ~ , , u ~ 9 ~~1~ Pufi6c S~etr ~~f I I~mda 1 ari ~~?f ill l o ~ ~ sooK ~ ~ /G ~ ~1y Commi~si~~n e~}~irr, . ~ IT~~ hr r~r.utrJ in du{~li..:~c~ .~nJ ~~nc~n.~l fdrd ~~~tf~ llcrl. l'rt~+nt l'~~nrt..~nJ duphratr ~~~Ih ia~ A~~es~~~rl ar'-.` . r-~r' . _ . . * . ...:-a~ ~ ~ . . . . . . r'T^~= t"'. . : ~ . ~ . _ _ ...:~+_,g""Y~