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Declaration of Domicile and Citizenship
4L~2410
TO THE CLERK OF THE CIRCUIT COURT.
~.5 ~ V c l ~COUIVTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing thin dq in accordance. and in
conformity with Section 222.1?. Florida Statutes.
I was formerly a legal resident of HA W O R rH _ _ ~ f and I
(City) ~ Istaal
resided at ~ ~~'0 S f
~ C T l9 V ~ _ _ However. I have changed my domiu7e to
(8treat and Numhar)
and am and have been a bona fide resident of the State of Florida since dal ~
_ 19 - and I reside at ~ ~ S • Fo ~ y R ~ o N D y LAM
18enat and Numbarl
~o ~T s T. ~ v ~i ~ S ~ ,C, v c ~ ~ county. Fleriaa.
1(1171
and this statement is to be taken as my declaration of citizenship. actual legal residence and domitxle in the S4te of Florida.
1980 APR -9 Al111~ I 0
D fiNO ~ N``A.
. ~~~~T S
~K~lltl~IT
~v~~lEo
.432410
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State. •
~ I FU THER CERTIFY that I have no intention to return to my former domic~7e. and I intend to remain in
~O R T S T. C- vG % £ _ ,S ~ ~ ~ ~ E - -County.
ICit7)
Florida. permanently.
~',C- ~-tx' rc--
r
(Hama)
_ (Addreaa)
Sworn to and subscn'bed before me this ~ day of ~ 8 O / .S . /C ~ 'r-Kf.i
A.D.19~0, ~ ~3~~Z
_
Na.gpe~C
sou b[~"lOad. i~ '
My Commissiod exp[res ~ ~ - 1
(To be a=eeuted io duplicate and or iginal filed with Clerk Circuit Coin. to with T 1
BI>{ltlgK~~~J PdGE ~~e) I