HomeMy WebLinkAbout1537,,'~-, ~ ~Jr~
Declorotion of Domicile and Citiie~nslip" r, :~A.
TU THE STATE ANll COUNTY TAX ASSESSOR,
ST . LIICI E COUNTY. FLORIDA
This is my declaration'of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of OLATHE - , - - KAI~:~,AS _ - - -
~ Ctity) (State )
and I resided at RT• 1 - , _ _ - However, I have changed my domicile
(Street and Number)
to and. am and have been a bona fide resident of iile State of Fluriiia SiT,Cc 1st day .;f
APRIL 19 80 `and (I•e4ide :;r. 320 Shsdy-- Lanw8iv4r Park
~" (Street and Number)
k''~'-. _-PIF•Fi;CE ---- . -------- ST. -1,UCIS CO - - County, Florida,
-- -----
(City)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
(lnaert here any pertinent facts, such as sale of roperty or business, or relinquishment of employment at
former domicile, removal of family to new domicile, purchase o1 home, etc.)
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F~~ ",!!J REDO ~ED .,
~y61 FEa -3 pn IZ 5S
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
and comply with all other requirements of 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
~----------FTC -PICK----------~-----=-------- - ----~ -----ST.---LIICIT--------------- ---------------- --County, Florida,
---------------- --
--
permanently. ~~
(City) ~~~~45!~~k'---'- -~~l.Z.~~Lt-~-~~-----
(Name)
lti ~
Sa,~•~• ~~tx'ibed before me this-_-_-3- _---day of
. ,, ~'
- .
ROGF~t PQITRAB=~ --,-- - RCUIT C
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...... ' ~.`' ~ _ A.
---- ----E..__OAEOLII----ALLY- ---- - --- ----------- -
(Addresa)
DEP. CLERK
(To be ezeented in duplicate and original
No. ~ 8uool~ t'o.. Plant Cltr. Fle.
with Clerk Cirenit Court, sad dnplieata with Taz Assessor)