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HomeMy WebLinkAbout1795 . ~ ` : ~ ~ E_. . .R ~ . . ~ ~~~~,:~~~~~1 e~ ~~~~~~~z~ ~~e~ c~~~~~~~-~::~;~~ ; f "I~U't711: ~TA~I E. n1U ('OUN7'Y "f11X ASSI:SSUIZ, i it T ST. LUCI1: ~ , ~41 i . - c•c~u~v~r~, r•t.c~it~nn: ~ . , Tltis i. in~~ cl~cl:?ralic~n c~l' Uomicil~~ :incl Citizrl~xhi~~ in thc Slatc al' Flurida that 1 am filing this ~lay in :ircc~rcl:n~rr.:~n~i in conf~~nnity ~~~ith S~ctioi~ ??,.17, f~lorida Statutcs. f i 1~vas formrrl}~ a Ir~:al ra'si~l~•i~t c~f,?/(~.~~~~ QN__ ,~~~-/!..f~4~ _ and 1 ~city) ~alr) ~r.i~lccl at !U b(? _-~~J-' . Howcvcr, 1 havc changcd my damicilc to (Sitcct and Numhcr) ~ an~i am and lr~vc brrn a hcma li~lc r~sid~nt af lhc Statc of l~lorida sinc~ day ot 19~ and 1 rr.id~: at _ ~~'3 - - - - > . ~ - - - -(Strccl.anJNumLcr)-- st. Z.LiC2.P_ CUllri~y, r•i~~~~.~, - - - - - - - ._i~d this stat~:mrnt is to be t.ikrn as n~y ~lcrlaralion of citi't.t:nsl~in, .ictual legal residcnrc and domicilc. iii thc Statc c~f Florida. (Inu•ri hcrc any pcrtinrut f:~.ls, tiuih a~. ~.~1.• uf pruprrt)' or hutiur~. or rr5aquishmcnt of cm~la?ym~nl •ut furmrr dumicilc, rrmu~:d uf family tu oc~c.duuiici!c. putchasc o( homc. ~~tr.1 , 1:';T??LZ1~'G GHILD:~.T: i'~ SCHC~OT_.: IiOP~:STEAD F~.E:~iP'I'IU'~: ~ if enterir.g chilc3ren iz1 scliool, ~ ; pleas list their i~ar~es: - . .C~-~ c ' fILEO ANO RfC~~ tT.~{CIE COUN ` 1lOCER POITRAS CIERK CIRCU~T COUIIT RECORO YERIFIEO..~..~~ ~ ,~w 11 2 34 PM'IS ; ~ 299541 ~ ~ ; ~ , 4 - s ~ i r ~ r 1 • ~ ~ ~ ~ ~ 1 I~UkT11ER CI:R'('lf~Y that 1 will re~istrr at my local a~ldress when the rrgistration bool.s reo~,rn, and { com~~l}~ wilh all uthrr rec~uir~mcn:s c~i :i Ic,~:il r~ssdrnl of tliis Statr. ~ ~ . ~ ~ 1 I~U 'tIf1:R~RTIFY tlfat 1 ha~•r no intcntion io mturn to m~~ formrrdomicilc, and 1 intcucl to rcmain in ~ ~ ' ~ s;~. Lvclr { . _ _ - - . _ , Coemty, ~ 1~IoriJa, pcrm:~n~•i~tl~•. tc~~Y~ - ~ , ~ ~ / A~~.~~~~. ~ ~ ~ " ~ . _ , • -$I~it~Ti%~ - - ` , :'l~`r J' ,I ,~0~;~ - _..~ri1C~'~~_~'- ~.Uj-~1 ~f - - ~ ' ~ a= ~ : ~ ' ~ s IG~~a~~~t~ . ~ . - . = ~ : .:t; . ~ ~ ~ ~~t~wut'i~~i.,~ri~,~~~y~ril~rd hrforr n~r thi. 7 da~r ~t ~ ; ~ ,yt~: _ w:.` ' _ ~ ~ ` ~ ~ .n.i~. ~ /s 3~ ~ ~ . ~ L~ _ - - , - - - in5~.c~'.-i *_-c s s _ a .~;~'ITRA~T, CI.I;t2iC C7KCUT'1' CnUit~_ „r ~ - - ~ i~.., ~ - . e ~ I3y " cNt~t.y Cl~ r'- ~ ~ ~ (Tu br r~reu r 1 ~n dn~~l~r:~lr :~nJ nri.•mel filyd ~:u4 17rrk l'ire~nl l'uurl, a~eJ duplic~tr ~tii~h "!a~ A~scso-u~) ~ BCCK~~ PAGE~ /~74 . ~ ~~s.~_ _ . _ . . . . _ ~