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HomeMy WebLinkAbout0237 Declaration of Domicile and Citizenship 'f0 THI: STATt: AhU ('OUn"fY ~'AX ASSl:SSOR. 2~3~~ .S"f E ('C)UNTY, f~LORt!)A: Tl~i~ i, my drrl:ir,itic?n at~ i)omirilr an~! Citizc:~ship in th~ Statr ol' Fiorida that 1 am tiling this day in a~cor~tancc•, ,~nd in ront~onnity with Srction _'„_.17, Florida Statutrs, ~„';:t~~t C~~~~..~Iww'~ d~ j~[..c.v ~ . !7 T C_ -Tc~ S~e•- • nIt - . f Sf~u ~ ~'~_s <`an~ O~ :1I1(~ ~ I was fonnrrly k~l-f~i~l 1_ 7_ 1: s . Fl~ 1~ - - i/? ~s~*P~l r'~~~71~f~p^ ~ ~t~ vs•7.irs ((5tY) ~Statr) - S ~ . . rc~rctc~t-a - - - .~`f'l't> _ P~~Y . Howev~i, 1 . ~Strret anJ Numt+rr) ~~~r~,,,, c.?~•yp c~%~I .T 9~.«1~,,.s~~• , ;~+~e1 am and havr bcrn a bon;~ fidr residrnt ot' tl~r Statr of Florida sincc .,~~~__~~.-S-t:~.. ~..,l~~.7j: ~ 3 t~ A1 cn IS~n/.i t a..fy a.~ fl.e t.f Nr...,r ~ c~ 1 _ "~c• ` 19. ?_s__. ~ind I msidr at~ _ ,2ttl~-''S~~!'--'-'~"~'~----- f ~ (Street and Numbrr) _ l~~~ _ S~~~rc,, af ~'s ~~q~p'__iz _ ,~1,~'-i~~i,. =~I °d.T~i.~^~--- !SJ~ _ COUtlty, Florld:l, ~ ~ ' (c~~~> f~. Y.;,.z.,.y - ~i9~s and this statement is to be takrn as my declaration o1~ citizenship, actual legal residence and domicile in the State of Florida. ((nsrr~ hrrr rn> ~~rrtincnt facts, surh ac wlr uf pruprrty or Ausinrss, or relinyuishmrnt of rmpluymrnt at iormrr - Sc~micilr. rrmu~al uf famih~ tn nr~~ dumicitr. purchasr ~~f humr. ~tc_) , ~ ~ ~ 1-~ . 1 l~c - E'-l ~L' ~6.F ~!ta L /lYas~ G.-.-~r_ - ~l ..r c. .c:- J 4_ F=~% r/.. ~c-~<_.l .V- ' s~•~t~-c< f ~ • _ L - ~ nrcc`Y-~ ' • : ~c ~)IZ.~L ~-4 ~~'t~[LLI~:~ C 1 ~~.-t~~ w,~ - ~ -7 - / z::. ~ ~ r ~ I~.a..t_.-. ~ ~Z~':x..."~j• f~- f~"-rl '!<-~z~-t`/ Q-.K- ~'t~~-~'t J`~ „ : r,~. ' • ~ ~ - 3 t~_ ~ 'E . a s,~'~=~ , ~ ~Sa - ~ s - S~/ ~ ` c ~ ; i . I' .y~ ~L. ~ t l T t- c~P _ : lSii / • ~ ~ l J f LEO AND RE qR 0 ~~v~ f . ~ ~s ~ ~ ` ~ lUC1E COU~ri ~ ~ ROCER POITRAS ~ 3~~ c' } CLERK CtRCUiT CBURT ~lf i' RECORO VE~tF1FQ~~'; ` J~ i 11 s4 ~M'13 ~ 258310 ; 1 FURTHER CERTIFY that I will rc,_ist~r at my loral address w~h~n the registration books reopen, and ~ compl4 with all oth~r requiremrnts of .I ItLifl f~Sl(~Cllt Ot IIIIS SI1t~. i ` I FURTHER CERTIFti' that t ha~~e no intrntion to return to my fomler domicile. and 1 intend ro remain in ' ~ , . : /~t ~ 5 f~ L., ~ , _ - - - . - - ~'~._s• ~ County f - _ . s Florida, p~rmanrntly. i ` _ - ~ ~ : _ , - ' ~-t ~z.:-~-~-_ . r - lName) LJ ~ ~~C~^ ` S ~ T- -~fn-~---~S=S. f1, r'....,y~, ~ - _ ' (AdJrrss) ~ 7 ~ .c , f . / - ' , ~ K ~ ~v: .•$yirt~tt ~fo aMd. s3t~.cribed hrlorr mr lhi, cl,«~ of c~ J 5 o W r A K : _ • - A. D. 1 q _ ~ c~-. ~.-_s' f ~ 3 . _ 'f ~ _ - - - _ . . :S'ublic State ~~f.i•iasN{a aN:~s~e- v P~. rg , v - /?'~e.~~ C c, ~ e ~ ~'o ti t"Y My Cottrmi 'ssioti~expires -l~yr Com~;on Ew;res 11-~7-74- ; (Tu be rtrculrJ in Juphra~. aiiJ nr~cin.d (ilc•d ~.ith ('Icrk (itcuit Courl. ~nd dupl~ratr Nith Tar Asscssor) ~ 3n~r ~.J ~ . ~ ~ ~ ~ ~ _ . -