HomeMy WebLinkAbout0175S~~ ~ 22?
''~ tt~ CQUMTY~
Decivrvtion of Domicile -ond•'Citisen:hi '
P
TO THE 8TATT AND COUNTY TAX ASSS880R~
8?. I.IIOIS COUNTY, FIABIDA:
This is u-y decLration os Dornidle and dip ia' the State of I+7ar3da that I am Aline this day in
accordance, and in conformity with Chapter 2i:2, Section Pi~.17, Florida Statutes.
I was formerly a legal resident of______~_IaL ~) ~, _~p~( ~_--~~
~aau a iBaicieu ~~_~~as_.±~_v_~gr~~_~~i.~s~,j._._ tiiuis~~~,----•----. liOwal/er, 1 I1aVe ChaJ1~+Ed n'ly d0
(Strt+at sad xaenbaef)
to and am and have been 'a bona tide reaidcmt of ~}lA 4~ta of Fk-rida ,i.±.~ , A __-~„ o:
-------___--- Jsl__Z____._._.__.__~____, 18_ ~, and I reside a~Bt~..~_.SOZ.~.a3~_-I,i~i~~id--c.~~.-____---
(Stew! sad Nombar)
(fib) ----County, Florida,
and this statement is to be taken as my decLration of dti:~ship, actual legal residence and domicile in
the State of Florida.
(Invert 1ss• sap pe+rtiatnt lasts. such as t+ab_ o~ _Dzo ~r ~ i~•. ~C~ia6mnat od alnplo~maat st
former domietln. ramoral o? laeeeiy to nets . Parcbast•
., ,., .,:
~,~ ~ '~
.~•~ ~.
•~
~ . , '~_.
~_
.;~ : - ~ -
~'
szis~~
I~' 1~-_^~~K
.~,c Pt11 i ~~:;:~, :~~ . .
5i. LUCIE COUNTI, FLtii::.;A~
I FURTHER CERTIFY that I will register at my local address when the registration hooka reopen,
and comply with all other requirements o! a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
in Ts3T~e_~l2Q! _-- , $ ~._Connty, Fkn3da,
(Cib) -_______L___
permanently. --~_ __- ---------------
(xan..
. Charles Y; ~sY
.•
,.....
3~ro+~'Tr'Eo and ~ f beZore me this--- 5------3~-y of
--~-~~~t~' A. D. 18_13,.
~, ~fot~~ta}ils 8ta0sy[ llozida at I~s~e
. : •~ ~.•~~ I~fotar~ -uMC. 6bM N Floelda at Lar
(To bn a:vented is dnDlkats sad oritinai Sled wltle Ae~rk Clrsuk Gnu aced doalieab with Tae Awt~vr)
Bowen aapDb CY., PLOt Clt~, ttta.