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~ec~arat~on of Dom~c,~ia end C~tiz~nsh~p
TO THE CLERK OF THE CIRCUIT COURT. .
~ COUNTY, FLORIDA: -
Tbls is my declaration of DomiciM and Citisenship in the State of Florida that I am tiling this day in aoootdana. and la
oonioraiiLl? with Section 222.1?, Florida 6tatutea. .
I was [ormerllr a legal resident of ~~5 /_Q ~ - T~ S and I
tt2tyl leee~ • -
resided st However. I haw ehsnged my domids to
" ~ 19~t aed NwsO~tl
and am and have been a bona tide resident of the State a<Floelda since ~ S~'~ ~ ~
~J ~ ~ ~ Q T_ ,19~. and I reside at o~ ~ 0 D ~O. yC~ ~R~ Q ~ l
(BtcMt~Nrmbd
~O Q Y ~ ~ E i~G ~ S'T. L. t•CG 1 ~ Coenhr. Fto:id..
luv~ _
and this statement is to bs taken as a~ deeLration of dtisenship. actual legal residence snd domicile in the State oI Florida.
t9T9 SEP t 7 ~ t 0
a~.f T cow
a~coRa vEat~~o '
~5~9200 l~
I FURTHER CERTIFY that I will register at m~ local address when the registration books reopen. and comply with all
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 Lo remain in
- County.
lCaq) •
Florida, permanently.
Judith A. Schur t
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F-- •~i : t r~ :~s ~ ~ it fvq~rrl e
c :ica ~ ~
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Sworn to and s~byyac~ibe~d before me thin 11th day of
A.D.19 79
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M ' ox ire. Consul ~f rho .
r , ~p. ~ „ _ ited states of America OR
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