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Declaration of Domicile and Citizenship
45059
TO THE CLERK OF THE CIRCUIT COURT, ~ .
COUNTY. FLORIDA:
This is m7 decLration of Domicile and Citlsenship in tbs State of Florida that I am ~ thk dai7 in aooordanos. and in
eonio~nit~ with 3ectioa 222.17. Florida 8tatntee.
I was formerUr a legal resident oI - 9%L t~~'.d.~A and I
tCiet~) 18tftel
resided at a / ~ ~~'-Frf ~'Y _ Howevee. I have el~anged ap domidle to
asd Nasbarl
and am and have been s bona Sde resident at the State at F7or~Wa alnos l ~ ~7 ~
__,19~~. and I reside at ~%1a!~ ~l~yt~ ~ ~vr"is~yl-
(8terft sad Nasfl~d
E = L ~~Gi
c~ ConntY, Florida.
tasl
and thb statement b to be taken a. mr declaration oR oitir+enship. adtul legal nsideace and domielk is tbs State d Florida.
~o~E,eT ~o,dssJv
GG
/C i~Cf„o,e. ~ ~~eJ~J~LG .
~y,J r~,~,o ~°rs,-~,;oS 1919 !?U6 -T ~ 2 15
~ 2~pRp VERYIEO
454.059
I FURTHER CERTIFY that I will register at my local address when the regiftration books reopen. and oomph with all
other requirements of a legal resident of this State. ,
I ~~7 that I have no intention to return to my former domicile. and I intend to remain in
FifR'1~ iE.~~~" _ zST- GL/~ . Count,
1cScr?
Fbrida, permanently. .
_ rz
.a: -
k... ~ ~
(Addraaal
Sworn to and fubscribed before me this ~ dad of
l s
Ro OITRA ,~~7 C le.~ K _
tTo be a:eeuted io dupliate and ocisinal med will Ckrl Cicenit Court, and duplicate will Ta: Aa~aaaor)
e
ao~~3~4 P~~E 238 ~co Foy ~l-~ ,