HomeMy WebLinkAbout0509
ib~i 5 509
Declaration of Domicile and Citi~~~IJ~nt HA.
TO THE STA'l'E AND COUN'rY TAX AS8F&'K>R,
31' & LUC1E oom.rrY. FLORIDA:
Thia iJl my dee.lal'ation of J>Qmiclle and CitbeDlhip in the State of Florida that I am f\lin, thla day in
accordance, and in ~n!ormity with Chapter 222. Section 222.17, Florida StatuteS.
J waa formerly a lep.\ reaicient of'______._.EAS.T-- rnSOB ..1,^ KFS ,.___.__u___.. N..e){._J..ar.s.~---.-.-"---.-
, (City) (State)
and I resided at..., .._ Butler,~.J...u--..---...--,-.--.-...... ..'n.'_________. Eowever, I h,we chan~ my domicile
(Stnet aDd Number)
to ar.d am and have been a bona ~e resident of the State of Florida since ,...,____3rd ,.._nn,m...,day of
h..m_...,.__J,~~~-I"y,.-..m----u--.-'" 19_9J-., and I reside 5.L___,~~.15_~~~~~l V_4.l-.____~~~~!'.Q9,~J?_~!:~ t
(Street and NuQl}:,er)
. ___m___m....__"m____.__.f,~.~.? J:.~r~-~-, ...r l i)rt~~._.t R ~.!.__.~...~~~ _~J eg.L_...,._.__m___u.'__.._ ...___County, Florida,
(City)
and this gUitement is to be taken as my declaration of citir.enship, actual legal retlidence and domicile in
the State of Florida.
(lnMrt here any pertinent f&Cu, ..ucb u ule of Ju.operty or bualDeu. or re1inquiabmeDt of empl"ymat at
fonnel domleU.. I1Imonl of famllJ ~o new domieUe, purehue 01 home. ..)
. ..' ~ .' I . t . : :
93040
FILEr- .f.,NO HECOP.DEO
I~j ~~~\MM~?COK
I~~;";- ! '1 p~J '}. ')3
. .. ., . ~ ;; [. ,;
. '.' ~ ~ \, 1..: .
.,.' -. ,
." ,... '. '- ",'" .
.: '.:~ f ~.. ". 1 ~ "-
. ,:
'. -
, '
t .: :-: ".
~ "'...:. - f -
ROGER POITf1t,S, CL:r-,~
(' ,"- "~ \", ' 'LJ\u'
~, .' ' ;,' O-O'\'
"'. ~.
-...... ~
'. ",' - ,~: " ." . ..'
-'. ../ .... .
, .,
,., .". .""'\'-- .......
. " ''O 'to" ....'
"
. ..,.\"' .
I FURTHER CERTIFY that I will register at my local addresa whl'n the reaiatration books reoJAln,
and comply with all other requirements of a legal resident of this State.
I FURTIlER CERTU"'Y that I have no intention to retunl to my former domicile, and I intend to renu,bl
~;:;:;::.;;.....u.Ft..f~c.e..u.. .......n...... ....u... -"''''''''~ft... Luc1 enu." .u' County . Florida,
_..__,__.a)AdMl.--- _" -- -- .- ,~u...---.---.
~~~i~y~~LEt J~.~,____."__":!i~~~,.-- _1--
:~
, ,",'J,. '. '.-,
, ... ,
, . .... .... I ","
~!~~ ~~sU.Q'kiibed before me this__J..O:th,daY of
~.: :'.~, ':"P.:.,:, .. "."".~ --:.. .
~~~...-l4.&r-ch-~.--.---.._--u----..-.-., A. D. 19_&..
_' . ..,J ," : ",
',~1m 0 T~ ) CLERK CUlT COURT,
-~i'-r:'. " ' >>.0-.
,', . t J ~ . ,
__u...rC"_MiMiett '
~~~_..__.._-"-_.._----
(To be ueented in duplieat. and orlcinal ~led w!tb Clerk Cireuit Court. aDd duplicate with Tn Apeuor)
R..-" 8aollly Co.. PI.ol C1fY. ria,