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Home My WebLink About0911 Deci~raYion o# Domicile and Citiz~nship r~ Tttt: s-rt~Tt: n~u c'UUN'fY 7~AX ~~sst ssoK. 2~83'73 , _ ~ c•uuti~rv, f=l_ORII)A: _ Thi. is my ~hrlaraliun ut~ Domicih and Citiz~nship in th~ Stat~ uf Flo~ida that I am liling this day in :ircor~lancr, and in ~anlorm:ty with S~ctiun ,,,.17. Florida Statutrs. ~ ~ !~'-~-1.-? ~'ci.• . ii(Cc 2 I f~vas t~urn~~rly a I«:+1 r~sidrnt c~i _~'fcRC'G~` ~nd I - - - - - - - . ~ , , ~ ? tst.ta) ~ . Now~~~~r, 1 have chan ed m domicile to R~Il~il.~ :!l - - - - _ _ - - - g y (Strret and Numtrrr) :~n~i am :u~d havc br~n bona lid~ resid~nt ot' tl~e S!atr uf Florida since day of ~ I~ ~ c~t.uc. t-t.~,~-_- . 19 , and 1 rr,idr at T~!)/_ S_ _`.dG`~~ : f ~ _ IStrcei apd I~lumbet) ~ ~ ~ ~_t_-~_ - Count Floritla, :~f f~.-~2%z-t-~ _ _ _ - - - . ~ ~ - - y. . ? ' ::nd this statem~nt is to br taken as my declsration of ritizenship, artual lega) residenre and domicile in the State ~it Floricla. (In.crr. hrtr am• prrtin~nt factc, such as vlr of pro{+rrly ~x Ausinru, ur rclinyuuhmrnt of rmplo~'ment at formrr Jumicilr, rrmu~al uf fam~ly lo nr~c d~.mic~~r, purchalr of home, rtc.) r~~'~L- f~_-f~~~-~ r / ~4 i 83'~3 FILEO Ay^ =:cGORDEO ST. LUCIC C:l'JNTY F~A. ROi: . " '~AS CIf~K Cr ~~~i ~OURT Pf~r.~r, y:: ~r~.~~ FEe 23 15s PN'T3 ~~`,-L~ i ~ ~ I ~ E t ~ 1 FURTHER CERTIFY that I wil! re~~istrr at my loral address ~vhen the r~~~iitration books reopen. ~nd ~om~~ly with all other rec~!~ir~ni~nts c~t~a le,~al r~sielent of this Stat~. ~ 1 FURT iER C~RTIFY that i ha~-c no s~itrntic~n to rcturn to my forn~~r domi~ile, and [ intrnd to rema~n in ~,c-~2 L~ __,~~f' ~ . ,u - - - - - - - . - - - - (otu~ty. F=1ori~l~,.pcrmanrnth-. ~'~~c`~ „ - t . : ; ~ ~ ~j / ~ . ~ , . . . ~ l;_ ~ J/~2,~ _ -lNiLsi. - _ . 1~~ - ~ _ . ' (\ame) ~ .r , . , ~ . . ~ : l- = : _ . ~I . W ~ . ~ ~ . C7 . . 3 - ~ f / . ; ~ ` ? - _ _ . . . _ . . _ _ ( t,l~~lCSS) . ~ ~ ' ~ ~ ~ ~ ~ ~ ^~~•~~rrt Ec:~,.~-itid >N~~4~rihed beforc m: thic ~ ~ day oi ~.1Q\'Y~ ~ = ..~,c G- ~~c a < J~ - - - . A. D. 1 ~ - - ~ l_ ~ _ ` . ~~L !.~-I,,~ . G~ C• f<-l~~ ~ ~ ~ - . . - - - ~ Nutary uhlic Stat f FlnnJa at I.arc. ~ ~t~- ('ommission e~~?irr -L ` ~1~~ ~ ~ ~ (To`fir e~ecutcd in dupl::rec anJ nn}~nrl filyd ~cith l'krA ('ircuit ('ourt. and dupli.~ate with Tax Acsessor) ~ ~ s~x211 ~ 91i - - ~ ~ , - - _ - ~ F ~ - , _ _ _ ~.f . . _ _ .