HomeMy WebLinkAbout0978 . , - .,~<.~.~,,.__..__r__._
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r~1~s~1 , / ~ D~CI.~?R1ITION OF DOMICILB ~
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Ta the Clerk o! the Cirauit Court [County Comptrollerj T, ~(1 ~/G,~ County, Flori.da.
This is my daciaration o! domioile in the S~ate of ~~~QQ/(~~ , that I am filinq
thfs day in accordanae and in oonloraaity vith.8ection 3'Z'~:T7; or ~$tntutes.
•!'OR DOMICILZARI88 OF THB STATB OF FLORIOAs ~
i hereby dealars that I resids in and iaaintdin a pldce a! nbode at _~-J~ a~ /1~?,c~ 7~~Q ,
A 'Ts~'~ee~ an n e T"
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fr= . in ~,T ~ L~ C-~ ~County, Florida, whtch pl~ce o! abode I
secoqnis• endYintond to iaaintain as my petwanent haae and, i! t m~intain atsoth~er piace• or
plac~s of abode in soa~e other stata or states, i hereby declare that my above-described
s~sidene~ and abode !n the State ot ~'Iorida~ constitutes my predaainault ~nd principal hane,
and t int~nd to continue !t peraar~ently as $uch. i am, at ths t o~ makiaq this declara-
tion, a bona ~ide residen~ of the 8tate o! Plorida reaidinq at ,
n e un n r
l'1~~;~~ 4r c,.~ !c County, F2or3da. i~oraier2y resided at
city)
^ . ~ ~ ~~lC~G.-' County. , anc9 the
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place or places whe~re I maintain another or other place or p2aces ot abode are as follows:
t~i~re list stre~t ~ddresa, city, county and state ot any other place or places of abode.)
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~ the state of Florida a~/ . ~ , P
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Sworn to and subscribed before me this,~_ d~y of , A. D. 19 ~,~o.
otary Pu c ate o or a n rge.
, My Commission expirea • .
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~ ~ ~OGER : PoIT~1s , t~EERK ~IRt~IIT OoIURT '86 ~ OEC -5 P ~5
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FOR DOMICIL~T~l~IB~ ~ STATES OTHER THAN THE STATE OF FLORIDAt
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I hareby~~ec2ard llaat my ~oraieile is in the State of and that I intend
to permanently continus and maintnia ray dmnicile in suc ata e. t t e im~ of makinq this
declaration I am a"boaa lide resfdent o! the State ~g . My place of
abode within the ~tate o! Flori~a, if any, fs as tollowss ere s s reet address, city,
and county of place ot abode ~n Florid~.)
t8arson makiaq declaration n~ay also include auch othez and furkher facts With reference to
arsy acts done or performed by euch person which such person desires or intends not to be
construsd as evidencing any intention to establish his domicile within the State of Fl~rida.)
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Swarn to and Subsc~°ibed before me this day of , 19
Not~y Public, State of F~orida
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