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HomeMy WebLinkAbout5011 1 ~ Deciaration of Domicile and Citizenship i~c~ ~r~i~~ ~-~,~-rt_ ~~~~v~~~ti~ -r~x ~ss~ ssok. 244980 S r- ~ c~c~u~~-ti•. t~ ~oKi~~~: "fhi. i; my ~i«laratic~n ~~i Uc+mi~ilr :in~f Citiienshi{~ in th~ Stat~ ut' (~I~rida that I am fiiing this day in .ir~urelanc~. :in~1 in r~~nti>rmit~~ ~eith Sertiui~ ~_'_'.1'. I~~i~~.is St;titstz~s. . p~ i~ti;i, ti?rm~ri)~ ~.~;~al rr,iclcnt c~i~ ~C~~ - . (/_/7! and 1 a . 1(lt)) ($lale~.._ . r~~.i~i~~l at ~~53 ~l10. ~~R d . Ffawr~~rr. I h:ive ~hangrd my domicilr to IStrirt rnd Numhrr) .~n~i am an~i lia~•r hr:n a bona ti~ir r~si~lent oC th~ Stat~ uf l~lorida since duy of ~C -f_ . ( ? • 0 8~ ~ - oK.f Sf Lar~ ~ ~ . .?ncl t r~,id~ at 3_ _ c.~-~Gf , (Strret anJ Number) ~ T- ' ' ..~cc~.~t - . ~~-~l_ ~~~s~ C~-1- _ Couniy, Florida. ? a~i~l tt~is stat~mrnt is to hr takcn as m>~ d~rlatation at~citiz~ilshi~~, actual legal r~sidence and domicile in thr State c~t~ Florida_ ~ - (In,~•r. hrrr eny prrun.nt fa~ts, wch a~ vk uf ptuprrt~ ur hucinr~s, ur rcfinyuishmrnt of cmpluyment at futmrr ~~un~.ilr, rrmu~~l uf (atnit>~ [u nr~~ J~+micilr. purat~ax uf humr. rlc.) ~,r: _ / ~~'y~Lt G~iti li1 c- G'~~'l [ C~~ ~ / ~ V ~ / / s~'~~ t.L ~l c C_._ -/c ~-c- .2-! Cf .~N , _ V , ftlEO A1tD RECORDE~ {r~ iT. ltiC1E COUMTY F~ ROGER POIT'RAS C ~ CLERK CIRCWT COURT RECORD VERIFIE~ J~ +I 4 a~ PH'13 244980 I F= l~ Rl~! If-: k(-F. KT1FY tha[ I will r<<~i.trr at mt~ iocal .uldr~;s ~ti~hrn [h~ r<<~istratiort hooks rec~pen. an~3 ~OIlllt~~' N'illl :ill ~,tf~~r r~c~±:ir~•m~n[~ ~?f ;i (~~~~.il r~:i~t~~nt c~f t}u: St:tt~. L ' ~ F['RTHl~k ('I~KTIF~tt~at ! ha~~ n~~ intrnticm tu r~turn tu m~~ t~orm~r~lumi~ile..ind 1 int~nd to rrnr.?in in ~ - r 1 _ ~ , ~i_L~ V~-.~+Gt'-C G~ . .~~l5:~~7 - ~:i f"~'f [:~C--~ 1~ ~t~ ? _ ~ Olill~)'. ~ Fl~,ricl:i. nrrman~ntl~•. f~tt,/j EN ` . !2 . ,.,u~.~~.~~,~ ~ ~ , ~qi / 7 ~ . • i n S~_-1~~-.~-- ~ % ~ :~~~f.I' ~ i~~ ~ : ~ J ~ ` - . - ~ ,7~~~ . . 1\amel _ ~ ~ ~ ao . . ~ r, ~ ? ~ ~ ~ E-- • ~ . ; - f - : ~ : - ~ ~ ~ \ddr .c) . :,~,Jl_~v:~,,= j~.~v~~~e !"~1~'~ ~t1;iXn'~`ctian~t~S~~rihe~l h~li~rr m~ thi~ ~ ~1.+~• c~t ~ r _ . A. f). t ~ ~c G G~ N~~ta. f'uhGc $t~t: uf 1 I~~r~da at 1 ar~;c ( ~ t~ll)IIIIS>llltl C\~l~~i'~ 1 ,~j - ~ 1 T~~ hr r~~~cutrJ in ~fu~~h.etr .~nJ ~~n,in.il filyd ~~rth ('IrrA l'~r.nit ('~~urt.:~nd Jupl~.atr ~.ith ia~ A~cc~snr) a~~209 ~~f~00~ _ - „ _ z., _ . _w - _ - ~ ~ ~ z ~