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Declaration of Domicile and Citizenship
TO Tlit: STATt= 1\'I) ('UUN7'Y "1'AX ASSESSOR. 245090
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_ _ ('OUNTY. FLnRlDA:
"ilii. i. my a<claraiiun ut~ Uomicile an~f ('itizenshi{~ iii thr State ot~ Florida that 1 am Gling this day in
acror~an~r, ;uu1 in ronlormity ~vith Srrtiou _"_'.17, Florida Statutrs.
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I w~s tormcrh• :i (~~;~1 resi~irnt of -~E!~ lt' " _ ~~1C ;~nd 1
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rrsi~iei1 at ~~~!~?'l,~ /.~:~~~~~.J<!.~~~'l~Iti'<: _~i~ . t~~~w~ver. I havr changed my domicile to
(Sttrrt anJ Numl+rr) -rf
1 LL~..
an~i am an~l ha~~r b~en a bana lidr rrsiarnt of the Stat~ ot~ Florida since _-~Id---..___ day oi
_ . 19 .~7a-, and 1 rrsi~l~ at ~~v,t'._l
f _~L~!1_~!C' 1..~~!vG ~
n~ _r.. (F>trert and Number) '
- ' f ~ __S~~ ~~C_Y-,!~ _ . • C-.~~ Cou~tty. Florida,
(c•~t, ) - -
and tfiis staternrnt is to be takrn as n~~~ drelaration of~ citizenshi~, actual legal nsidence and domicile in the State
ut~ flurida.
(lnxr. hrra any prrtinrnt f~rts, ~uch as salr c,f pruprrty or Ausinru, ur rrlio~uishment of rmploymrnt at formrt
Jum~c~lr, rrmo+al ut famih• tu n~~v dumiril~, purchasr of homr, rtc.)
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lUC E COUNTY f~A. ~
ClE KcCiRCU1T COl1RT ~ .
RECORQ i/ER~f1Ed„~~ ~
•~M 8 I I 38 AM'13
24509p
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1 FUKTHt=1t (~l_RTIFY that 1 will rr~~ister at my loral address H~hen thr re~istration books reonrn, and ~
<<~m~~ly with all c~thrr reyuirrm~nts c~f ,i (~zal r~siJrnt of this Stat~_
1 I=L'RTHE ('t:RTIFY tl~at I l~.~~~ nu iizter~ti~~r~ to rrturn to m~r t~onn~r do ~irile, an~l 1 in[cnd to r~main in
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- - ~ _ - - Counly.
Fluri~la, pcrman~ntly.
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~ ' ~ i ~i! ~'~4-`~-! .~^/I/1. L`~_!~-__.~V.S.r~/~l~.'~//f.'.'_- / 2
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'S~torti ihR~ritied b~for~ m~ this ~1a~• ot F
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- A.U. 19 .
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ta~> Yub ic State e~f ! l,mJ-r al r
M~• ('ommission ~~~,irr, f~ ' _ SL~~K~.VJ P~tt,~~,iVp
(T~~ hr r~rcutrJ m dupGc~tr .ioJ ~~n~mal f~lyd ~~ith t'krA ('ircuit C'~~urt. ~nJ duplic~te with Tat Assessor)
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