HomeMy WebLinkAbout1395
~~
D~ciaration of Domicile and Citizenship
.
5131~9
TO THE CLEEtK OF THE CIRCUIT COURT. ~
COUNTY. FIARIDA:
This is my declaration ai Domic~e snd Citizenship ia the State ot Florida that I am filing thia dsy u- accos~dsnce. and ia
contormity with Seclion 222.1?. Florida Statutea.
I v-as tormerly a legal resideat oi s~~ Ti~Td ~y ~" y• and I
ICit~) IStatel
resided at 3 S//9/~~~ S~ ~~ . However. I have changed my domicile to
~svn+ ~a x,-me.~f
and am and have been a bona Gde resident of the State oi Florida sinea ~~~ ~ , dsy oi
e~i ' 3° .19 ~° aad I reside at 6 O'2 S. c, ~' ~~ e G y ~ ~% _
. (Street and Number) _
~C /,'_ ~ S~. ~ ~i L ~ ~- , •S'~ . ~ ~f G ~ ~ County. F7orida.
(Cit~)
and this statement is to be taken as my declaration oi citizenship. sctua) legal residence and domicile ia the State of Florida.
i9~1 J~,t~ _ I 2 P~; 4~ 00 '
~Q[ C ~Af ~_ ~Lf~i.F G i
5 T. WCtF CCUy i Y. f t:..
ROG~H POITRAS
CLEHK Ct~CiqT Cf~L'~; /~ ''
F~~,"..a~;:::~: ~ . ~~~.f .
~ i~ `
S] ~1~9
I FURTHER CERTiFY that I wti71 register at my local address v-hen tKe registration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTH~R CERTIFY that I bave .ao intention to return to my tormer domicile. and I intead W remain in
• p 2 t- S'T- L y C.~ ~ -S T.~. U c: L- ~ County.
ICit~1 _
Fiarida. permanentiy.
, ~
~ ~ ~~ ~ ~
~~' C ~
/ , ~ ~~ Z?
r~ 7 IN
~ G~ s . .~':' /~ ; C~~' ~ y ~l-Y-'_
~ , ~G _ ,~ ~ (Ad ~~~ • J~,~. -S -~/~~
%~~l '
W a~d~f~ before me thia day af
.- ~~~~N..;;~/ -• _ A.D.19 ~ ~
.. _ ', ~,
' ~ ~ `t3 T.~ n . . .
• Y ~ ~, t /
~~ y~.~. Notae7 Publie ~ 07 ~7orida ~t Lrp
~ ~ r•
; ~... , ,~ ~ a:~~ :
v~l ~~I i q M ~~: N~II
t, ~ A. A.Ic J~la ~
y '~
(, c~t S. E. h- dge ~y a~E •
..n ,r
•, • Q~• ~~*; RObtY Pu~tt, $~a!~ ciFir.:i _a ~4 larr_t
Mp . C•~. ~•~•~i~'~, ;•-NCy Ccmmic:i~~ Er.pires Oci. ~! ",~'
~_ ~.~...
•• ,,,4 . . k.~.~C d~ io.cc~e iss S :...w.~r -~ :.u~ _
. . !U_ ~~g~ .
1?o be esecated ia duplieate aed origina: Aed with Cietk Circuit Court. ~ud duplkatt witb Ta= Aaes~or)
aooK346 PaGE 13y1 , ~,, ~.._.~ ;, ~