HomeMy WebLinkAbout0970 _ _ _ _
, _ - ' ~ -
DECLAT2ATION OF DOMICILE 64~~4
ci;e ~"'1c2•:, oi t: e Circu,t Cc~urt [Ccunty Comptroller) ~ Cocnt~?, Fl~rid
.
:c -~v da:llration ~r '~~::~icile i.~ the State c+f ~ , that I am filing
~hi~~ d~v in .~ccorc~i*..:c ~nd ~n ccniorcr.iG}~ c.~i.th Section , Flaric a Statute~.
~•,fi •'IC:i.,?~RIES OF' 'I:lE :~'."\TE t;2-' Ff.URIC.+:
_':~~re~r.~.• decl~rc that I r~~sz.le ia anc? mair~t.:in a place of abc•'e :~t: Q ~~1~
' ) . stree an~ nu~ er
°~~'T ~ , in L_it4,~ County, Flbrida, wl~ich place uf ab~de T
~it~ ~
~ni z~~ Y ieit:and to r,~aiiitain as ~1 perma~nent home and, if I n~ain}ain another place ~r
i;.1~.~ :~r ab:~.it~ ic? ~c.:~` otaer rtate states, I hereby declare that my above-described
zes_der.ce and abod? in the State of Florida canstitutes my predominant and principal-home,
and I intend to contin;ie it per•nanently as such. I am, at the tir~g of ma inq this declara-
.:::a,. a~ona fidc resi3ent of th~~ State of Florida residing at ~0~.~ ~'a,L~1lrr7lT1
- . street and nur~ zr -
, in County, Florida. I formerly resided at
ity
, County, ~ - • ~ , and the
Ic ti
y ate
:::~ce or places where I mair.tain another or other place or places of abode are.as follews:
!ii~re list :~treet ac~dress, city, county and state of any other glace or places of abode.)
- ~ -
; r~x~:: L~ -v~rn~~z~~t rt.,i~ier:~r in Iy~-~_~
f . - (~rint n
C1'.~' ~L.,'-•,' U1 ~ ~~I'1G~~ t7i1 ~ .
- U
Tsigr.ac:~rAi
~ t,c~.t 7 / ~V d `/Yk ~v.fz_ (print
,«::t,tiue; ~
~ pU
~ t~' ~
_.:.q~?~k~ .;~~~~~~y".~b .:i : e_~~r~r ti~is ~S da}• of , A. G. 19 dT.
: _ `.''i~i~.Y
f '
-?~~3;;,~;'~ ~ c: 6~08'~4
-,e,:~~~.
s`'~=~ ~a .o~ F;.:~~ ,.:a
3~:~:1r~;E~: PK ~ 5~ .
~ ~n ~ ~-i ~ - ~tx~: ~M JAN 25 .
f l • • ` _ ~ ~
. ~
i~ • 1
~ ,:,tN~~.i•~yj6 ; . ~~~~C ~k~ t
~ri' r
~ ' IUCIF CCi~i ~ : . ,
~~''•.e~~. C~~i~~~i~,.:;~; J hOG~"PF'C~IF~:.S ~
F~:~~
j[}~~r, L~~ I,ZIi~,~,2~1 l.~~i CLERK CIF.CUti CCU~i L
~ 7_i,~.~~: . . ~.C C't: •
s~r. a.~ E cxxm n~~ -0°
~ j~_, . c;: _
~ : -r~-x~.-~~:
~
: -
~ ~
7JMiCILtn:~~.~.'S O'r STATES OTNER ;tiAti ThE STATE OF FLORIDA:
~ere~.: ::~clare th3t My do^~icile is in th~ State of and tna~ I intend
- ~ Y~z :;aner~l~• continue and maintai, my domicile in suc state. At the time ,:.aking this
~ laration I a:~~ a t~ona f id~ r`sident af the State of My place ~f
~:,~~de witi~in the ~tate ~f F2orida, if any, is as fcllows: liere ist street address, city,
::3 c.,::nty af place of abode i~ Florida. )
: er,:o: :..~kir.r, tlf~ctarat:vn :r~ay al~o incluz~ such other and furthr.r facts wi~h rc~ferer~e to
_:.y ,cts d~~re ~r perfor~ned b}• such per~on which such person desires or intends not to he
~ ~::t: aed ~~idencir.~ any .intentio:i to establish his domicile within th~~ State of £i•~r~?a. )
~
s-
~ •
€
~
~ ~ -
f
j~ ~ igiature
~ ::nd :~ui~s~rib~~~i heC:,,-~• mc~ this day of , 19
a -
~ :u~::~r~~ r.:hl ir , _;t-.:t . : F Z:,rida ~ ~ P1Gf ~7 iV
bUOK`t~.~? ~
~
_ . . . ~
~ - -