HomeMy WebLinkAbout1232 Deciaratic~n of Domicile and Citizenship
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TO T E ST TE AND COUNTY TAX ASSESSOR,
_ COUNTY, FLORIDA:
'[l~is is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformity with Section 22 1 Flonda St tut
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I was formerly a legal resident f , and I
~ ~O ~~c~'~~ (citr) (state)
resided at . However, I have changed m~ omicile to
(Street and Number)
and, am d have been a bona fide resident of the State of Flori a since ~ day of
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, 19~, and I reside at
(Stteet and Number)
` • ` County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. •
(Insert hete any Qertinent facts, such as salc of property or business, or relinquishment of employmmt at fo~mer
domic~le, removal of family to ne domicile, purchue ot home, etc.)
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To establiah residence in the Stete of Florida
Sf
lUC1E CO~Mt1~f s~
~l.ERK C RCU
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RfCORO ~~R~F?EO
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~ I FURTHER CERTIFY that 1 will register at my local address when the registration~books reopen, and
~ comply with all other requirements of a legal resident af this State.
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l I FURTHER CERTIFY that I have no intention to retu to y f rmer domicile, and I intend to remain in
F
~
i , . County,
~ Florida, permanentty. J HOS
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S 4~• C~J~~G It f-L~~~~
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' Sv~o,jn~fv,a~d.~ubsc~i{ied ~efore me this ~?~h day of '
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e i~ • , A.D. 19~.
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~ RO~~f#~POITRAS, CLSRK CIRCUI
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~ 7 s h~--- D. C.
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~ (To be executed in duplicate and original fded with Cittk C'vcuit Court, and duplicate wilh Tsx Assessor)
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