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Declaration of Domicile and Citizenship
~'7'136
TO THE STATE AND COUNTY TAX ASSESSOR,
/ .
~ f- k ~ ~ ~ _ COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that i am Ptling this day in
accordance, and in conformity with Section 222. i 7, Florida Statutes.
~le~e ,'sa~ ~t ~ , /e ~ss~~
1 was formerly a legal resident of X1 1~ and 1
(Citr) (State)
resided at ~ ^ . However, 1 have changed my domicile to
csc~~ ~a N~~.e~) ~
and am and have been a bona fide resident of the State ~ of Ftorida since day of
. /
, t 9s~~, and I reside at ~a su SF i~ U' ,
~ ~ (Street sod Nuanber)
iL! ~ ~ , ~ ~ ~ ~ County, Florida,
(citr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~ ~
(lnsert here aay pertiaent facts. such ss sale of property or business, or relinquishment of employment at former
domicle. removai of familr to acw domicile, purcAase ot home. etc.) ~
This is to establish that I am a legal resident of this .
County, and also, my son WILLIAM SCOTT CHEAVES,
is a legal and permanent resident of this County, and
is now attending the Universitp of Florida, Gainesville_,
Fla .
~9 AND REC
iT lYC1E COY~~.
ROQER POITItAS -
CLERR ClRCU1T COiM~
RECORD YERIFIEO
~!R lO ' ~ 20 ~'~Y
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s
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to former domicile, and I intend to remain in
.
, , County,
Florida, permanently. cc~~r~
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3o f~o7 ~ ~
. twaa~)
Sworn to and subscribed before me this ~ day of ,,~+~s`.".
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My Commission expires ~
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~•y
(To be e:ecuted in duplicate and ori`inai PieA with Cterk Ci~ty ~'`~Od dvplicate with Tu Asfaror)
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