HomeMy WebLinkAbout1029 Dectaration of Domicile and Citizenship
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TO THE STATE ND COUNTY TAX ASSESSOR,
~y~~: « _ COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accorciance, and in conformity with Section 222.17, Florida Statutes.
1 was formerly a legal resident of _~~,~,el~~~ ~=~tc~• and I
(citr) (State)
resided at . However, ~ I have changed my domicile to
(Stteet and Numbet)
and am and have been a bona fide resident of the State of Florida since day of
_ , 19~y and 1 reside at ~ G
/f~ ` (Street snd Numbet)
o~U"~-~1'~- , ~ ~ County, Florida,
(c;~r)
and this statement is to he taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Inseri hcre any pertineot fscts, such as sale of propeny or businas, or relinquishment of employment at former
domic~le. removai of fsmily to new domicJe, purchsse of home, etc.)
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- ~ ROCER POltRA= - d?
6LERK CIRCUIT COUAT ~
RECQRO t/fRIF1Ep.,,~,~'~'
Ar~r ~3 12 s9 PM'1Z
, 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.
I FURTHER CERTIFY that I have no iniention to return to my former domicile, and I intend to remain in
' ' - /~c~. u-~ , CountY,
Florida, permanently. cc~~y~
, ~ ~
~`.~'f~ ~
(Name)
(Addtess)
Sworn to and subscribed before me this ~ day of
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t~lotary 'c Stale of ' s at Large ' ' ` • • ` ; p ~
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ission expires ~ r~G 7 ~ ~ -~a " -r ~F;~
My Comm ' ~ - ` ~ dOpK PAGE~Vz~
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(To be executed in duplicate and original tded with CIe4! ~J~
~nd duplicate with Tax Assessor)
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