HomeMy WebLinkAbout0662 Declaration of Dornicile and Cititenship
TO T T D COUNTY TAX ASSESSOR, 22'~'133
.
COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that [ am filing this day in
accordance, and in conformity with Section 222.17, Florida Statt~tes.
. ~
• .
I was formerty~ ~ i~ ai r~ide~t of ¢-E - - and I
( ty) (State)
.resided at . However, I have changed my domicile to
(St~eet and Numbet) . ~
and am and have been a bona fide resident of the State of Florida since day of
~
, 19_____., and I reside at ~ ~
t.pa H~mc~)
.
d~-s~~ -~-~~tet-~. ~ County, Florida,
(cnr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the $tate
of Florida. -
(Insert here sar pectinent facts. such as ssk d pwperty or business, or rclinquirhmeat ot employmrnt at tormsr
doaiic~x~ remors! ot ismilr to aew domicile, p~chase of dome, ete.)
.
.
~ ,~~"w¢ ,~_~2~- ^
2~2'?`133
~~Sci~ cou~~i?~~.
R46ER PO11RA~
CLEAK CIRCUIT COiMt
IIECORD YERIf1E0.~..~.~.~
Att 11 oi P~I'i~
. I FURTHER CER't'IFY that I will register at my local address when the registration books reopen, and
comply with atl other requirements of a legai resident of this State.
1 URTHER CERTIFY that I have no intention to return to fo er icile, and I intend to remain in
t
, County,
~t~Id~;~f~r~anently. ~cicr . ~,,~~r~ .
:,~~~C ,.......,?~r r,
: -
, ; ,
_ ' : .
: . ~ : ~ E~ -
- ' ~ . G : ~ 1 _ ,L'~
va~' d
F'•. (waa~)
' ~ .r"~
`D~`•• .
~d~!`~ubscribed before me this ~ ~ day of
' ~rplitstti~
A.D. 19~ . ~
a-c.,lc,t~ (D
Notsty Public State ot Florids at Larse
My Commission exp' ~~~E ~
~
BONDfD 6EMEP~,L 1lISURAN(~ O~.tiE~naKiTEJiS .
(To be e:ecuted in duplicate and oriaL~al fied with (7erk Circuit Courf, anQ d4ptieate with Tu As~etso~)
daox~l ~
A(-O F;~rci '+1 ?7
_ , _ _
~ - - ~
- ~ -
-'~~..~`~."s~' ~t.~~` . - -