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Deciaration of Dor~nicile and Citizenship
"CO TNl~ STATE ANU COUNTY TAX ASSk.SSOR, ~
S~' COUNTY, FLORIQA:
Tiiis is my ~lrrlaration at' Domicilr and Citizcnship in the Statc of Florida that 1 am filing this day in
accordanr~, and in conformity with Section I7, Fiorida Statutrs.
i was formerly a hgal r~sidc~tt oi~ _~!Cltima-t ~ / ~ .
- ---~~~~~°^V`a- and 1
- ;~tate)
n sided at _ Z _ _ ~L ~Z _ . Howcver. l have changed my domirile to
(Strert ar.d Numbrr~
and am and have tx~en a bona lide residcni of the State of Florida since -7-Q-~' day of
- ~?'u`~~ 9 7.3 ancl t resid~ at /.SS -
- - -
c (Slreet and Number) ,
I~- ~N - - - - - - . :
` County, Florida,
(cti~>•)
and this stateme~~i is to br takcn as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
Unseri herr any prniornt facts, xuch :u salr ot pruperty or businrss, or relinyuishment of rmployment at formrr
domicJe, rrma~al uf famity to ~ew dumicilr, purchase af Aome, rtc.)
~ ~ ,yI ~
~ Q
f,+ 7t CG24t c~ L/ ~-~~l.lct, Cc--~- v~-'~-'~'
24~59
s
ST~LOCAF COUNTY FtA
ROGE~. POITRAS
CLERK C:~tt1tT COURT
RFCnRD v=~rtlEO.~~„~,~
~
J~ 11 I 23 PN'?3 ~
~ ~
~ ~ ~
,
1 FLRTHER CERTIFY that [~<<il( ngister at my (orai address ~vhen the rcgistratic~n books reo~er~, and ~
comply with all other requir~m~nts of a Ir,_al resid~nt of this $tate. ~
i
1~URTHER CERTIFY that I ha~c n~~ intrntion to return to my former don ~cile, and I intend to rcmain in
~ ' ~ ~
~-c.Q
• - _ -~,c,c-<--Q _ _ _ . - - - county
Florid:r p~ift~nently ~c"` ~
v~ y~ ~.a , F~' Q ~ ~
: n :
~ ~g-~-c~
• ~ : • _ - - -
- _ _
(Nam - -
. ~ :z
` G ~ " = Robert L. Berger
j~ ~ II L :v
l. • ~ . ~ - - - - - (Addrru) _ - -
l . .
~ ~ ~ ~ 0 \ ~ -
3wo,~it~ t~, a~d suliscribrd h~ for~ m~ this _ ~lay of
r
- - _ A.~. i~~ 3 ~ ;
~ ~ ~ ~ ~
- ~~.f~C_ ~c~~c.f~_ - - -
- - Public Slat uf FIur~Ja at Lar~r
ti~)' ~~O111II1ISSiOT1 l'X()ift. =a~~'' ~ ~ / / -
(To br rcrcuted in du~hratr anJ nri~innl (~Ird acith ('Irrk C~rcuit Court, and Juplicate ~cith Tax As.uswr)
. 3~~1! ~•J ~Cf 2~34