HomeMy WebLinkAbout0697 Declaration of Domicile and Cititenship
TO THE STATE AND COUNTY TAX ASSESSOR,
~I ~-uC I ~ • COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that~ l am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes. ^r
I~:..Q f~**nPrly ~ legal resident af -~N/3.~~r !a!o 1G • and I
~City) iSt::e~
resided at x~-3.~ ~~~~$~~~-~nLp
S/1~t~.1R~.. However, I have changed my domicile to
- (Street Numbet) .
and ~ am and have been a bona fide resident of ihe State of Florida since ~~~Rl~. day of
, 19~y and I reside at ~d.~ ~S N.~~Y, !~'iv~~ ig .
(Street snd Nua?ber)
~a,pT, ~i~R~ , -s"1_" ~Cu C i - County, Florida,
(c~ir)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. '
(Inseri here any pertinent fscts. such as sale ot property or businas. or reliaquishmsnt of employment at tord~er
domic~e, remorsl of tamily to new domicile, purcdase ot home, ete.)
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; 1 FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend ta remain in
~v~~' / /~R ~ ~ , .~f -u-c.c.~ , County,
Florida, permanently. <c~eY~ .
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~";.,~$~J~pxnXaet~c~,ibscribed before me this day of
r{no~~
A. D. 19~'Z -
cur~Ec.~i ch:,~~.~
Notarr Pubtic State ot Florida st Lu6e
My Commission expire •
(To be executed in dupiicate and ori6inal fJcd with Clerk Cireuit Coutt. snd duplicate with Tatc Asta~or)
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