HomeMy WebLinkAbout1292 Declaration of Domicile end Citizenship ~
- 43'7955
TO THE CLERK OF TIiF. CIRCUIT COURT,
LJ [ _ ~ .c COUNTY. FLORIDA:
This U my declaration of Domicile and Citizenship in the State of Florida that I am tiling this day in accordance. and in
conformity with Section 222.17, Florida Statutes. .
i= ~ O 2!~ - ^L? ` ~ and I
I was formerly a legal resident of - ~ l
ti~71
resided at o2 y / oZ ~l l 5 S E ~ ~ S 1-' - Nowever, I have changed my domicile to
(8treet and Nambar)
and am and have been a bona tide resident of the State of Florida since ~ ~ day of
J y L /'1i1 E 2 ,19~ and I reside at ~ ~ / ~ rnE~`~ N!~ /~t~
lS et and Number)
O ~ ~ ST. C i i= ~ [l C i~ -County. Florida,
r lCityl
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
~?LcD APiO RECOROEb ~ '
. ^~fr.~ ~r,~ Ri~:~C+
43'7955
'79 t~ 21 AM 9: OI
~ fl~TR..
. CLARK CiRCW i COURT
1 FURTHER CERTIFY that I wdl register at my local address when the registration hooka reopen. and comply with alI
other requirements of a legal resident of this State.
{
~ I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
• .County.
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r
Florida, permanently.
l ~
i
~ [Ilrgme)
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x , ~ (Addr~aal
Sworn to and subscribed before me this a ~ day of i,~~ ~ T JT ~ (J .C ! r'"
A e ~ ~ , A.D.19 7 9 _
Notary i'u ~ o(Florida at , ~ ~
My Commission expires `
~
NpTAl1Y OUBLR.' STATE OF R ~?t'!P. - -
~ Cc ..:••,~+ON ExvrRFS MtMIGI ~ last s •r u
^ MA'R:I.FiD 60NDY1f3 AGE11GYr ~~r ~I 4,~ w - +u.. _
- ~ ~ 305 a,~_ 1290 = -
~L ~ • AGO Form 71 2°
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