HomeMy WebLinkAbout1831 N'
Dec~at~tion of Domicile and Citizenship
TO T E STAT~ AND COUNTY TAX ASSESSOR,
_ COUNTY, FLORIDA:
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This 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 222.17, Florida Statutes.
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1 was formerly a legal resident of and t
Citr ' (State)
nsided at . However, I have changed my domicile to
(~:reet ana N ) . ~
and am and have been a bona ~ resident of the State of Florida since day of
~ , 192~., and 1 reside at ly~a~ ( v ~
• ~Q (Street aod Number)
~i n.c~~ d~- - County, Florida,
r~~ (c~irr)
and this statement is to be faken as my declaration of citizenship, actual legal residence and domicile in the State
of Fforida. ~
(Insert here any pertinent facts, such as sak ot ptopertr or businas, or relinquishment of employment at former
domicile. removal ot family to new domicite, purchase oi 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 CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
.
~ ~dr~ ~ - , COlJrity,
Flonda, permanently. ~A~? q, Q~e e
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l/ (Name
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(Address)
Sworn to and suh.~ribed before me this day of
`~ci.~" A.D. 19~1c
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My Cothnt~o~ex~ ~ - ~ _
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tf~~;~tuted in duplicate and ori6inal filed with Ckrk Circuit Coutt, and duplicste with Tu Asseswr)
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