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HomeMy WebLinkAbout0636 . ~~cE~::~~~~:~~~~~ c~~ ~r~ ::~E~ : ~ ~~~~r.~~ ;.~~~~c6~ 'fO 'I~I lli S'I~A'I~1: ANI) ('UU\"I 1' '1~.1\ ASSI:S~OIt. ST. I.UC11: - _ COUN'1'l'. PLUI:IUA: ~8624 Thi~ i~ nty ~I~clar;itic~n c~f l)c?micilc an~t Citi~~•~~.hip in thc St:ilc c~f Ilori~ta thal ! am filin~~ this itay ii~ arcor~t:u~cc, .u~~1 iit cc?nfurntity ~~~ilh S~rti~~n „~.17, [~lc~rida ~t:ttui~s. I w-as fc~rn~~rly a Irp~.al resi~lcnt af _~~.011__/~_~_.~-Y ,~~w and 1 (c'hy) ( tatc) r~sidc~l at _o~ a.~ W~iT --STR . Howc~~cr, 1 havc changr~l my domicil~ to (SUrrt aud Numbrr) and am and havr l~r~•n bona fidr n~iclrnt of ihc Statr of t~lori~la sincr ?-4~ day ol D EC ~I~t,t ~ E~ - , 19 7_ y and I r: ;ide at - ---1 - - 3~~ C . y (Strrrt and Numtxt) ~ ~ Sl' . Luc ie _ _ ('ount rlorida, - - - . - - - - - Y, _~_~T - - cc•~~>~~ ;:nd this slatrmrnt is lo hr tak~n as niy drrl:~ration of ritizrnshi~~, artual 1~•~al resid~nrc ~~~~d demici~r in thc Statc Florid;~. (In~er. Ill`It' :1D~' ~~l'(IIL•l'll~ L]lI?, \UCII :li SdSC 11~ ~\fU~)Cf~~ ~~r businc~,. ur trlinyuiti6mrnt uf rmpluym~~~t at formrr Jnmicilr, rcmu~:d nf tam~l~ t~~ urtiv d~.micilr. p:uch:u: n( h~~mc. rtc.l -T... t,~ ~ ~~~c c~~1i.nR:::: sc.~c?ol_: t~~, Lsci.~:.~ ~.x~~~,r~rYO~:: i~~ l._<IL.ZI ~ If eliterang children in sctiool, please list their narnes: e /-3 ~ ~ T ~ . /q ~7-, .~i ~ fILEO ~MC REC~ROED ST.IUC~E LOUN71f FLA. ` ROCt it PC:7RAS - CIERK ;,~,~~jj COURt RECORC YF:~I~~F~ T s 36 aH ~75 i _ " ~ ~ 298624 ~ ~ ~ ~ 1 f~t1RT11t:Ft CERTII~1' th:it I~+~:Il n;~i~t~•r at m~~ local a~ldrr~e ~vhcn thc m~istration books rco~cn, and ro~n~~ly ~vith all othrr req!iirrnicnt~ ~?I~:~ I~~al r.,idcnt of this Statr. I 1~URTIIE:I: CI:K1't[=Y. that 1 h:~~•r no int~:ition to return tc~ my fomicr domicile, and 1 intcnd to rrnia~n in ~ - s ~ . 1_uclr•. ~U~ T ST L u c /s- - _ . - - , C'aut~ty, I~lorida, pcrmanently. ~r~~r~ ~ . - F; a~'~,•,~V - . ~ ' . - - . - - - - c G,~'~TURI; - ..C~. ~':i~;• ~ , , s" ~~R ' ~ ~ •J . . ~ ; . ~ ~ ~ ~ • ~VV " . ~i ~ : . . . 'V~ 9.. t= . ~ '~t rf-'~ ~ - - - - - - - - - - - - ~ ~ • ~ , A ~ , ~ ~ • ~ S i Gi~it~ ,'URE ~ . -y~ _ ' G • - ~ ~ ~ : i `t . ~ . :Sl ~ : ! ~ t: . ~tt'.4R-t + . . t r i~gt~ ~~"~nci s!E ~~~c~`h~~fur. ~;~c t~ii~ T. clav c~f ~ - ~ "%;l- ~ ~ y.~ g{.~c ~ . ~ - ; - - , n. n. > > _ . ~ F ~ - 1'~^ 1 1 Ill~ ~1:1(' Z'E_' ~ S ~ ~ . . ~ _K~cL~r ~~i1T~ns, c;..~:rzf, ~T~trtlj~~~ c:c~t~~~ - rlo~~~~a a ~ • F;J ,eP~,t~- C'l c ~ (To he t~rci m du}•4r:.la an~) u~i~ ~n d t~~r.l .ti:" ~!f. ud l~nUfl. :•l~d ~~~:rl~. f:~1 Asscts~rr) ~ R ~ . ~~~K 235 PAGE 635 ~ - _ r~ ~ . _ . - . . , n.~.'._k