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Declaration of Domicile and Citizensh~i
•4s91~39
TO THE CLERK OF THE CIRCUIT COURT.
~ ~ . L u c i ~ COUNTY. FLORIDA:
This is my declaration of Domicile and CItisenahip in the State of Florida that I am filing this dq in accordance. and in
conformity with Section 222.17. Florida Statutes.
)e~~ W i irlF'e Icf _ and I ~
I was formerly a kgal resident of • ~
. , (City) l8tats
1, 1.
resided at ~.~s~~"~ ~ ~ ~ ` ~ ~ However. I have changed na1? domicIIe to
ISwa sad NoobK) ~
and am and have been a bona Sde resident of the State of Fbrida since D Q L 5 ~ d+y d
.~P C . ,19~., and I reside at ~ ~ 1$ ~ Vef
hfD~k ~r 1 V~____
LL (Strmt aaa Nambd
~r f ~ . LtC 1'2. ,~-f-. ~
J ~ ! 1 ~ County. Florida.
(Cixy)
and this statement is to be taken as ml declaration of citizenship. actual kgal residence and domicile in the State d Florida.
1
FuEO d?t l.oEo
$T.IUCi~ ~ FLA.
CLE~t ~ ~...,i ~~U~ RTf
DEC 12 10 15 M'1'~q
•459139
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
k other requirements of a legal resident ~ this State. ~ ~
i
I FU R CERTIFY that I bave tto intention to return to my farmer domicile, and I intend to remain in
P~ ~ . L..t.~U t? ~.LILi e? .County.
E 1(Styl
~ Florida. permanently. _
~ -
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f
's
Sworn and subscribed before me this ~ day of
c
Notary PuWie State d Flarids at Lep •
t My Commission expires / O~ ~ d ~ ~ ' ' _
tTo be executed in duplicate and origins! 63ed with Rork Ctrenit Court. and duplicate wtt6 Tu Aasworl
i fif AAI Mi~A