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Declaration of Domicile and Citizenship ~ L~
~s,~o~s .
TO THE CLERK OF THE CIRCUIT COURT.
. COUNTY. FIARIDA:
This is iw.l? declaration of Domidle and Citizeaship in the State of P7orida that I am Rl;na this day in aoooedancs. and m
conformity with Section 222.17. Fbdda Statutes: - - {
I vru formerly a kgal resident at ~ ,~~L ~ 1-Q~ ~ and I
lpcs) letatd
resided at However. I have changed nU domicile to
Nombd - .
and am and have been a bona Sde resident of the State et Florida since ~7 ~
19~ and I reside ax
. ( cad Nusba) _ -
- a 1~. - County. Fbrida,
td4)
and this statement is to be taken u my declaration of citizenship. actual kgal residence and domiet7e in the State of Florida.
4s~ls
I~ IIPR -7 PM I~ 36
FIl.EO ~NQ rEClt -
ST.I.UC CWN fLA.
RQGER rO1 RAS
1LERK CIRCUIT
;ltEBtH VftiF1E0
i
~ ~ I FURTHER CERTIFY that I ~ register at my !Deal address when the registration books reopen, and comply with all
M other requirements of a legal resident of this State.
I FURTHER/
i-~ RTIFY that I have no intention to return to ma former domic~7e, and I intend to remain in
~~~'~,A ~ 7,~s ~~~1,~ / ~ _ County.
(City) .
Florida, permanently. -
. ~$E'TZJ
S ~~rb~~ me this say of -
~ a[
My - OR
- . 6001c~ /1QE2;~~
i
I ITo be a:seated io duplicate and origiaal6ied with Clem Circuit Court. cad duplieitn wk1 Tat AaMOar)
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