HomeMy WebLinkAbout1496 Declaration of Domicile and Citizenship
' ~ 2;2'7689 '
TO THE STATE AND COUNTY TAX ASSESSOR, `
~
- COUNTY, FLORIDA: .
'[T?is is my declaration of Domicile and Citizenship in the State of Florida that I am liling this day in ~
accordance, and in conformity with Section 222.17, Fiorida Statutes.
I was formerly a lega! resident of ~QO~~-y ~ , and 1
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resided at ~ 6 0 6"/~ ~ D w/ . However, I have changed my domicile to
(Strect aad Number)
and am and have been . a bona fide resident of the State of Florida since day of
, 19__y and I reside at ~ '
(Street aad I~umber)
/rf ~~L J~" ~ . County, Florida,
(n~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
(Ime~t here any pertinent iscts. such as aak ot propertr or Dusiaeas, or teUnquishment of employmeat at tormer
domic~e. removal of familr to new domicile. purcAase ot home, etc.)
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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 TIFY that 1 have no intention to return to my former domicile, and I intend to remain in
.
~~.L ~c~~ ~ , County,
,
Florida, permanently.
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Mame)
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Sworn to and subscribed befare me this day of f
. ,
_ ~ A.D. 19~ . ~'1.•~ , .
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Nolary btic Stste ot Florids at Lsr - . ; :
My Commission expires - ~ . -
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(To be e:ecuted in duplicste and ori6inal fi1M wilh Gerk C~c~ t~q ~~uplicate with Tu Assasor)
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a~20i ~i494 F. .
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