HomeMy WebLinkAbout1515 D~aluation ot Domieil~ and Citl=~nship
TO THE STATE AND COUPiTY TAX ASSESSpR, „'~A
V
Sl. UKIE COUNTY, FIORIDA:
This is my decla~ation of Oomicile and Citi~ship in ttw Stat~ ot Florid~ that I am Htinq this day i~ aooord~no~ a~d
in oonformity wlth Chapter 222. Settio~ 2~Z.17, Florida Ststut~s.
1 was formerly a le~aai resident of 8~~11M
_ (Ctb) (5tata)
~ Oreddie A~ad ~ ' . However 1 hav~ d+~rq~d my domWl~
and i resided at
(Sh~et and Numbsr) ~ -
to and am and hsve bean a bona fide rosident of the Shte of flarids sinos 18th
Feb* , 19 67 , and 1 rosicJ~ at 1049 ~gla Besd
(Sh~eet and Number)
I~ORT N~ SAINT ttKif COUNTY, RORIDA
and thls :tatement is to be tak~n as my declaratior? of citizsnsl~ip, ac~uai fspal residenot and dankil~ in ths Stsh~of Florida. ~
qnsert here any pe~tinent facts, :uch es sale of propsrty or busines:, or re~inquishment of ~mployrr~t
st form~~ clomidla, romoval of family to new domidle, purcha~ of home, etc.)
:
~ -r
~ , . o_' d. .
~ntering ahildrea~ in school ~ ~ ~
RE~ORp yEjl1R =
- .t5gs49 -
~t JUt 31 - ~ : 99
~1~K CiR~U13' RA~
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i FURTHER C~ltTIFY that 1 will aomply with ali othK requinrr~snb of s lepai resident of this Stats.
1 FURTHER CERTIFY that ! have no intention to retum to my fomner domiqle, and 1 intend to ~emain in FORT
F'1~,;.S~1~+1'~-COUNTY fLORIDA permanenNy. .
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~ . t~$y?iorn ~ td'and , wbscribsd befon me thi: ~ dey of J~ 19 6?
; , • -
, - ROOER rOiTRAS -
Notary Pubik
Z~
°"''4~ D.C. My Commissio~ ~xplres
~To i~ aaarNd is dupfk~ta awd oeiaisal Al~d wMb CMelc NearM Cow1, and dvpliat~ wMi~ Tax A~~xa
~~67 ~151~ ~ -
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