HomeMy WebLinkAbout1723~bo~ 3 44~
Declaration ~o~E oumici~e~ and Citizenship
TO THE STATE AND COUNTY TAX A83$.930Ii.
COUNTY. FLORIDA:
This is my decLradoa of Domicile and GYtireaahip in the State of Florida that 1 am !llin~ this day in
accordance, and in conformity with Chapter 222, Section 222.17. Florida Statutes.
I was formerly a legal resident of___-----~---H~bQ~~----------------• ----------- ~ --------------
~..- -
and I resided at---- ~3_.-__~0~~_-~t~____•---------------------- ----- -~-- -. Ilowever, I have ~~ my dc~aiicile
- (St:wt sad Nnmbar)
to and am and have been a bona Ade resident of the State of Florida since 13th - .-___-__-_day of
-----____d ______-__, 19__6II, and I reside at___-_131--~~lit.<_Sttt~.=PGtt~_L~_Lu~id-----
- (Street sad Nnmbar)
----- -------1rT•---~'-~~------------ ---------. --------~.T..._I.IICIE------------------------------County, Florida,
-- (Ctrs)
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in
the State of Florida. ~~ cc
(Insert bate aas yertineat tuts. wcb as ss4 0~~yroPnreharN o oitC~~uLhmont of omPlorm~at at
format domicil. ramo~al of famil7 to new domicils D
~- •.. -
_ Z ~ -
-,,.=: ~-f, -
~_.
. „-. .,,
~ ..,
~~~$6
It_EC Atao RECOR ED
F _e0olc
~~, ~',~
ROG~ p0~'~ fLo~~ ~~~~
gT ~.vc,lE CoUW~
I FURTHER CERTIFY that I will register at my local address when the registration hooka reopen,
and comply wiiii sii ~tiici` icC;UiTcl'i781Ito :.: ~ 1C6 I resident o1 this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
_ ST..--LUGI3----------------------------------County, Florida,
(City) ~l }~-~
permanently. - ~Gf!~ _~~!!L~--------
------ (Name)
~-
.. ,~~h, -
t I, S,1 ~ `Jl/.
Swq~rC~ana,~Gb8t1'tbed before me this-----$Llxlay of
-; =-.
. ,~ .
.,, .. ,
.~~'>~t -~a~xes-c -- ciRCVrr c
,: ,
(To be ezecdted in dnDliate and original
Bowen BapD17 C~.. Pleat C1t1. Ple.
(Address)
DEP . CLEF
Clerk Clrenit Cotut, sad dnplieata with Tas Aseeseos)