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HomeMy WebLinkAbout0797 ~eclaration af norni~~le an~! Citizensh~~ 2~~2~ TO THt: STATt= ND COUNTY TAX ASSkSSOR, _ _ COUNTY, FLUR11)A: ~ - - - - Tliis is my ~lrcl:iration of Uanticil~ anJ Citiz~ nship in thr Stat~ of Florida that l am f:'.ing this day in accor~la~zc~, .~nd in conforniity with Sertion ~_".17, Florida Statutcs. ~ _ 1 was forn~~rly a lrgal re-id~~zt of L~-~CL!1' -1~ and t / ICityl (Stalr? / resided at _ - - --L-~'~~~! ~%C~2'~.~ - '~/O . How~v~r. 1 have ch.~nged my domi~ile to (St~:c and Numbrr) ~ ~nd am and have tx~n a bc~na lidr r~sidr~~t af th~ State ot Flori a since day of ~ . _ _ ~ ~ . t _ - - - . . _ . . ` - and ~ mside :~t ~1-- - j (Street and Numbrr) ~ ~ . ____~L~ ~'~1`~~ - • - --~-C'd ~ - Cot~nty, Florida, 1---- (Cit.• ) and this sta.ement is to be taken as my dr~larat~on of ritizenship, actua{ legai residence and domicile in the State at~ Flarida. Unaeri hrrr any ~+rrtinrnl facts, such as salr ut pruprrly or businrss, or rrlinyuishmrnt ~f amploymrnt at formrr domi~ile, rrmo~al of family to nrw dumicilr, purchast uf hume, rtc.) 1 ~r~~'~~'-~J ~ ~ /t'..~'.a1~r~ ~J . ~ ~ ~i~~~ , . F1LED ANC 9iCJRDEO ST_ ~UGIE ~JUMTr FtA. RGGf < ?~~;::i5 CtERt ~:=:i,iJtT COURT PF~~~? VE~:~r1ED ~ FEe 13 9 3i AH'73 ; ~ i ~ i ~48321 i - ~ I FURTHER CERTIFY that I will re~ist~r at my lora{ address when the registr~tion books reop~~~, ;in~i ccmply with all other requirem~nts of~ a Ic,~al rrsident of thi~ Statc. ~ 1 Fj,~RTHER_CERT[FY that I ha~~r ne~ int~ntioii to rcturn to mv t~ornier domicile, and 1 intcnd to rem~in in ~ vlt ~ . • g - , _ . Count~'- ~ - - - - ~--t--- - - FlQritla.;perr~adsaptly1` ic~~.? ~ . ...........G'•,, ~ - "L r~+ • ~ ~ _ ) ~ :';a~ z; ! i' L ; - - ; ~ ~i : - `f't~~ . ~ • ~ ~ = ~ l (N ) . . . , , _ ~ . ~ • • . 'S m , . ' ~ ~ ~ f ~ _ ~ - : , ~ : _ : r - • • : ~ ~ - ~ - - - - -`J- - - - ~t . ; ~ • v, _ j ~ ~t~aa:~~s) / ~ ~ . , , t.~` ~ ; Sv~Ojj~ti~n~~cribed brforc mr thi.~ ~la~~ ~f~ ~ - . lir!~.tit` - ~ . ~ - - A.l)_ 1 _ . _ ~ _ _ - - - ~ ~ 211 PACE .79~ ~ FtOGER QOITHHS CI~ - --1-f-~ c..._ ~ ~ C~ _ ~ ~ ~ • b00K ~ ~Ju r}' F'uhlic Statr~Fl~.nda rt Larce - ~ J ~ ~ ~~Y COIi11111SS10I1 l'Y(~IfES _ . _ _ ~ H ~ iTo br rrrculrJ m dupfi.ati ~nd ~~n~~n.~l f~lc:1 N1iI~ I~ICtA ~~ItCUIf Gltlfl. JfIII t~UltIKJ1C \~11~1 T911 A.~~l`W)t) i' ~ 04 L: , v~ ~ _ _ - ~ _ ~ _ ~ ~ ' ' " _ . . _ _ _ _ . ~ . _ . _ _ '?v-x~^-_• , r