HomeMy WebLinkAbout0963 , _ _ _ _ .
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~ , dECIJ1W1TI0N OF DWNICILE ~
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To the Clerk oE the Circu:t Court (County Comptrollerl ~ounty, f lc~rict,~
This is my declarat.ion of domicile •in th~ State ot ~ ,~ha~ 1 am f~:inh
chis day in accordance and in conformity with Sectio~~~ori3a ~tatutes.
FOR DUMICILTARIES OF TNS STATC OF FLORiDAt
Z hcreb}• daclare that i reside in and maintain a pl~ce of al•ode at _ jc _Rw~l~..~I?
s re~ anT m~ erf
~polf S~. t.~~. ` , in __S~ l.M~; County, ~'lorida, which place Of abodo I
c ty
recoqnize and intend to maintain ~s.my,pert~anent home and, if I ntain~ain nnath~r place cr
places of abode in some othar atate or at~tcs, I hereby declara that my above-deRCrfbed
residence and abode in tha State o! Florida eonstitutes :ny pre~iominartt and pri~cipal hom~•.
and I intend to continue it permanently as sueh. I am, at the time of makinq this declara-
tion, ~ bcna fide resident of ihe State of Florida residinq at io R,.}I~..J St ,
street an nnrt~ r'~' ~
_~e~l S~. L ~c~.~~, , in t~ . County, Flor.ida. i fnrmerl~• resi~ted c+t
city)
~a,~ ( xt~ G? r:~.,~ County, • , and t':e
st:i te
olace or places where I maintain another or other pt~cr. ~z• p:aces of abode arQ ~s f~ll~MS:
(':ere list street addre~s, city. count and state of an}~ ot?~~r pl:zca or pl~ces of at~cd~.;
1.: (etew td~••~j
at3 To~~.?~.Q RD•~ INcl~{s~~~ Atfa~~..~e Tlf, ~
n1l'~Af` dl~t~a~! •i~ uJ f9~}~ 1'Oft~ , Q!C/GwT/~ ~f~~~~lr O~ ffl~../t~~ m~ A~r mw:•~~•• p.. •~t?! r`'~Ifi./
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I took rma~eent r~~idence in sig~xt~ _
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the state of Florida cm ~ ,~11q,1~. ~
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;w rn to ub, c~ibed . faze me this ~(p~ day of ~~1~('~_, -A. D. 19~ 3.
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j RACE-R PdI~~,~~'~CiERK CIRCUIT OOURT
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DOMICILIARTES OF STA:~~S OTHER THAN THE S?'ATE OF' FLnRInl,:
~ereby dpc2are that my drmicile is in the StatP of and th~~t I inte~d
~~ermaneritly continue a:~3 maintain my dom3cile ir. suc~-~;ste. At ihe tir.?e of makinq !h~r
~larution 1 am a bona fide resident of the State of My place nf
~~3e witfiin t~e State of F?orida, if any, is as follows: ere st strec~t address, city,
;c9 cou~ty o: F~lace of abade ia Florida.)
~erson m~king declaration may also include such other and further facts Wfth referen~e to
acts done ~r performed by such person which such person desireR or intends not to bc
:nstrued as evidencing any intention to establish his dcxnicile within the State oE F1^ri~a.:
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F~.fC ~KC Lt''GP.^f I? - , •
st.uc~~~rc,c;,RSha.
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ClERK CtntUiT (.GG~: g~nat~e
.rr.zn~~:r:~~r .
5 worn to and Subs bed befare me this day of , 19
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' Mr_ary Publ i Sta*e c~f Fl~ri c~a ~
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