HomeMy WebLinkAbout0297~ +~
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Declaration of Domicile and Citizenship ~
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514~90 ~
TO THE CLERK OFTHE CIRCUIT COURT. • .
~ _ ~~~1~ COUNTY. FIARIDA: ~
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This is my declaration of Domicile and Citiaenship in the Stste of Florida that I am filing thia day ia accordance. and in ,
conformity with Section 222.17. Florida Statutes. ~ +
I wss formerly a legal resident of ~~~ . ~~~ -1"- _" "~ ~ I
ICit~) - ISut,t) '
resided at ~~ ~ ~- • . However. I hsve ebanged my domic~e to ;
lStrret aad Numb~rl ~ ~
and am and have beea a bona fide resident of the Stste of Florida sinee ~~ da~ of
' ,19_~, aad I reside at a o.~.~i S r. . SL-~'~''`-
Q,~ ( and Numb~)
, ~ ~(j • ~ . /~~ ~7~~,p _ Count~. Florida. i
(C1t7) ~
and this statemeat is to be taken as my declaration of citizenship. actud legd nsidenee snd domic7e in Lhe State oi Florida.
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F1tEC RNC F_COri1~ 0 i
5 ft~Q6~R PO TRAti~~ j
CLERK CiRCi11T CO!JF'.i ~ (
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51~#290 ~
I FURTHER CERTIFY thst I wi71 register at my local address when the registration booka reopen. and eomply witb atl
other requirements of a legal resident of this State.
I FUR~ER CER that have no intention to retura to my former omic~e and I intend to remain in
O~,A~ ~ . ~ ~ • . County.
1(M~1 .
Florida, permanently.
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Sworn to and subscn'bed before me this /"` day of
~~~ .A.D.19 I .
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Pnblie Sate d
My Commissioa expires M b-o~+9~~t{arpe
y COmmissi0n Expi~es NO~. 14, 19g2 -
(I3am~
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ERN es T G. L~eR,g eR
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(To be e:ecuted in duplieate and origir-d 61ed with Aerk Cireuit Courl. aad dupliute ~ritb T~ Aueaot)
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