HomeMy WebLinkAbout1346 F«m B. T. C-0OI-D ( S~M--P49 )
Declaration of Domidle and Cit~ensh~p
TO TNE STATE AND COUNTY ~ TAX ASSF.~50R, .
COUNTY. FLORIDA:
~4. T. LuC~E. ~ '
TLis is my declaration of Domicile and Citizenship in the Stste vf Fkrida tbat I am filing this day in aooord-
anca and in oonforn~ity with Sectioa 228.17. Florida Stah~es,
1 w~s formerly a legal resideat of GREEN BA~/ , WlS CON S i N
(~b?)
aad I resid~ad at _ I VL.'LW I M FORD ~1V~ However, I bav~e chang~ed ay donnici~e
a ~ S~'0~ ~ NOeI~ ~
t~o and a~'' ai~ hav~e been a bona fide resideat of the State of Florida sinoe Z9~~ day o~4
_ Aptz i ~ __;1~, I~,~ rc~P~~vr~~ av ~~vE ,vvrr~
~u E !!S, M
~ co~nty, Flo~ida,
(c~r) ES/TF . F~•Q7' . LG~C/E'
and this statement is to be taken as my declaration af citizenslup, actual kgal residenoe and domicile in the State
of Florida.
(Ia9ert l~a+e anY Pe~tinent hcb. such as aie ofp por basine~t. a reliaquithment af ecoplo~ueut at -
forma doanici3a r~awval of hmily to near ~Omicila~rd~tis of Doo~e, eec.) .
. ~ AM !~N OFFIC~2 I?J 't7-4E ZI.S. A2M~
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I FURTNER CERTIFY that I will register at my local addreas wheu the registratian books reopen, and
co~nply with ap od~er requirements of a 1eg,a1 resides~t of- this State.
1 FURTHER CERTIFY that I have no intea ' to reh~rn to my former doQUCile, and I intead to remain in
_ n~ n o~ , Co~ntY, Flo~i~a.
~ ~~°~y- ~T <srr- L~c~E /t~J,q~T, ~1~iV ,E. MAl~/~'~/ .~/~.3~f/7.~
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~ .S"9/~"~~t/S t'o. ,9~y D /f~ -
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sw to aad subscribed before me this ~ dsy of '
~ A. D.19 ~ v - ~
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Notary Pnblic Svte of at I~s
~irin~~IClv /
(To be esavted in dupllo~ts aod ai=inal EWd wfeb C~sk Cfra~it CourR ~od du~liat~ wit~ Tas A~wor)
~188 ~1343
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