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Declaration of Domicile and Citizenshi
A
TO THE CLERK OF THE CIRCUIT COURT. .
L OOUNTY. FLGRIDA:
This is pp deelatation of Domidle aad Citizenship in the $tate o[ Florida that I am Suns this day iA aooordanee. and iA
contormit~ witb Section 228.1?, Florida _
.
I was formerly a legal reaident ei ~ and I
ICii,~ ~ ~ (8trtal
resided at ~ 4.v~v~ ~sSC3- Q~/=-. However. I have
ehansed np domidls to
li~a..l..div~.e.rl
and am and love beau abona Sds resident at tbs 8tste adFlorida siuoe - S~ dq d
~ ~j ~ R
~,a..~~no~?-~ ~ i!_
~ and I reside at ' ~ ~ , • V
18trlst ss~ Nsstarl
1~, cent,. Florida.
and this atatement is to ba taken as ~ declaration o[ dtizenshig. aetwl legal residence and domicile in the state d Floeids.
119 SEP f 7 PN 2 t 0
S 1 LtR!<.'IANC Y. E A.
PO~~
CL~RCWT C
RECQAO VERIFIED
459201
I FURTHER CER14F'Y thst I w~11 register at my local address when the registration books reopen. sad eompl~ with all
other regnirements of a legal resident of this State. ,
I the i love no intention to return to my ~io~per dpnic~, and i intend to t+emain in
.~7.
11&rl
Fbrida, pesmanentl~.
Thous Stq
- - r.....,
IAdde~ad
Sworn to and substn'bed before me this i i th day ~ ~`~O N u,? y o~`L ' N y,
Se temberl, A.D.19 T9 _ ~~9~
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.,;'~v 1~.~' ~ in dupliab sed orl~issl msd wilts Clerk Cireuk C~ooK. rsd dupliats wkb Ta: Aaw~ _