HomeMy WebLinkAbout0694 D~claration of Domicile and Gitizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
.
COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am Fling this day in
accordance, and in conformity with Section 222. I Florida Statutes. ~
I~~•~s f^-:mprly a le~~l recident of ~ . , ~O~'`"'~ ' and I
(C~H) tstatei
resided at ` . However, I have changed my domicile to
(Strcet and Number)
.w"
an am and have been a bona fide resident of the State of Florida since~s day of
, 19,7~ , and I reside at ~~~G ~
(Streat and Number)
~!/i p~~G
. County, Florida,
(c~tr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. - ,
(Inseri hue any pertinent facts, such ss sak of property or businas, or relinquishment ot employmeat at toimu
domicile, romoval of fsmily to new domicile, purcAase of Aome, etc.)
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AOCER POITRA= .
CLERk C1RCUtt COUi1T •
RECORD YERIf1ED.,...~..~• /
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
compty with all other requirements of a legal resident of this State.
;
,
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
.
~ ~
; ~a-'t'c' -u.-c-c-~ , County,
i ~,Fl~d.~~'~egrt~Pently. (c~ry~ ~ .
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Sv~rorn~tb,and subscribed before me this day of
A.D.197Z .
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NO[ity p11~C Sla~ F~Ol/di i~ ~.ifE!
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My Commission expires `z'`""- ~S- ~ 9~ ~
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; (To be executed in dupficate and ore6ina! fded with Cletk Circuii Court, snd duplicate with Tsx As~asor)
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