HomeMy WebLinkAbout0364 w • ~ • • ~
Dec~arat~on of ~o~ic~i~ ~nd C~t~zer~~h~p ~ `
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TO THE CI.EP.K OF TNE CIRCUIT COUItT. ~~`^+v/~i ;
~_br~!
4e ~ COUN~TY. FtARtOA: ~
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This is my deelantion of Damie[le aad CitlsonsAip i~ ths 3tate oI E'lorida that I~m Ciltag this da,~r ta aecordance. and Ia ~
rrnfor.~i+r r?i~ti Gclw?n ?.22.1i. E'losi~i• ~!atufus.
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1 rvas toninerly a leg~l resident oI ~ i~. o~ i 155~55 ~~D ~ ~ I 4
lpt~) lSea 1 - .
resided at ~ ~ p~~ n1S ~ J~ . - However. I lure cAanged mr domleiM to
(ss~..e asa Numb~) ~ ~ ;
aad am aad have beea a bona Cde resident ot the 3tue ot Fbrida since ~ day ot `
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t~- and I reside at ~~P ~ o~ 1~~ ~ r+S ~l c~ • ~
t.s:r..e.sd Nu.eer) i
1 e 2.. ~ ~ or t~ A ~J ~ ~ i 1 G~ Count~. Florida, #
and thi~ statement is to be tskea as my declaration of eitizenahip. aetusl kgal residence aad domicile in the State of Fbrida.
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1lOQEa tottR~s 4
. - ~«~X G~qCUIT COURT ~ ?
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M~~~ I& 91n AH'7~ ~
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I FURTNFR CERTIFY thnt I w t~l register at my local addreu when the rrgistration b~wks reopen, and ccmply with aU
~ other requiremenls of a icga! resident of this State.
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~ I FURTi F:Ei CEB ' that I bave no intention to n:urn So my foraner domicile, and I iatc~d to remain in
! ~t ~1Ct`CQ~ ~ ~ ~U~ 1 c-e. , Count
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~ Florida, permanently.
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~ SK•orn to and sabscrE:wd ?:~fu: e mc this ?='i~_ day ot `
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~ Feb~:3r`f 1G~7 ~
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~ ,_,.C~_' _ . ? m :-.,.:Y
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~ ?1iy Gumm~ssion expires Irdei inite y p*
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1To bc ei~cuted i~ dupl::Rte and origi~,d f:;ed with Ct ~k Cirou[t C~:urt. ~~3 dupllcale rnth Tai A»e~eor) ~
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AG(1I'orr: