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Deciaration of~ Domicile and Citizenship
"I'U THI: STATL• ANU ('OUNTY 1'AX ASSI: SSOR. 2'7993'~
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Tl~is is my ~Irclaration ot Domicilr and ('itinnship in ih~ Stat~ of Florida that I am Piling this day in ~
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accor~laiur, and in ronti~rn~ity with S~ction '__'~.17, Floricla Statutrs.
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1 was formcrly a lr~;al rrsid~nt ot~ l~- -'Z- ;~nd 1
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) (Slate)
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r~sided at _ _ _ _ _ _ _ _ - - - - - - . Howcver, I have changed my domicile to
V y~C ~_,-v (Sirrrt anJ Numhrr?
and am and hav~ bern a bona lidc rrsi~i~nt ot~ the State of t~lorida since _ the first day ot~
y 1 , . ^ 1 `I
Januer~r_ 19 7~+ and 1 residr at~ =ie;_ = ~1 _~si_::'e -
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(Street and Number
:'t . Fl ~i c A ~ L~i~~ ie County, Florida,
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and this statement is to be tak~n as my declaration of ritizenship, actual legal residence and domicile in the State
ot~ Florida.
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(Insrti hrrc -rm~ prrlinrnt farts, such :~s salr uf proprrty ur bus~ness, or relinyuishment of rmploymrnt at formrr ~
domicile, remu~al uf family to nr~~ domic~lr. purrhaxe i~f hume, rtc.)
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_ ~ ~ y-:. 1 „i . ; ~ _ s .a _ ! 5 ~ other Vthea Jher former residence.. `
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° R~~ORO VER~f1~Eb~
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1 FURTHER CERTIFY th.it I will r~;~ist~r at my loral address ~vhcn the re~istration booi:s reopen, and
~ comply with all other requircments rt~ a Ie,~cil nsident of this Statr.
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~ 1 FURTHER ('ERTIFY that I have nu intention to return to my fonnrr domi~ile, and 1 intend to remain in =
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Florida. permanently. ~c'~• ?
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= R chard Allen Christian____ _ _ 4
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- ( : = % ~ 1~~'Y Ana Christian -
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Bureau of Navel Personnel (Pera 516)
: Sworn to;mt~d subscribed b~forc mc thi; l~'~ ~fay of Nevy Department
. ~ Washingtoa, D.C. 20370
~ , - ~ ~ - - _ _ . A. D. 19 _ ~~l'~_.
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• s E;~ Qfaty,NQblit State uf *Iwiir at M~e_ . t
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(~[o be r~rculyd ~ f~lyd wilh <'Irrk ('ircuil Court. )
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