HomeMy WebLinkAbout2317 Dec~ration of Dorn~;;ile and Cititenshi~
~
TO THE STATE AND COUNTY TAX ASSESSOR, s ~
~~~as.._~ _ COU~ITY. FLORIDA:
This is my declaration of Domicilc and Citizcnship in the State of Ftorida that 1 am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
1 was formerly a.lega! resident of , and I
~ (Citr) (Stace)
r~esided at /f'~ .~".u~L . However, I have changed my domicile to
(Street nd NumEer) ~
and am and have been a bona Fde resident of the State of Florida since jO~ day of
, 19~y and I reside at ~
~ ~ ~ , (Street aad Number)
~~-Z 1--~-r-~~ ~ ~ , ~ ~ County, Florida,
~a~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State ~
of Florida. ~
~ (Insert Aere any pettiaent fscts. sueh ss sak of property or busineas, or relinquiihment ot employment at tormer
domicle, removal of famIly to nevv domicik. purchase ot domt~ etc.)
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--~p{,£R P4~f
~LERK C1RGiliT C
REC~O YfB~FlEO
~ ~i ~Q Ol ~M'7Z
~ 228236
I FURTHER CERTIFY that I wiU register at my local address when the registration books reopen, and
comply with all other ~req~irements 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
~
~s~ /~~u,c.Jc,~ - ~~a.~ - , CountY,
Florida, permanently. cc'tr~ - -
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~SWg~ ~vand su iiefore me this ~ day of
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i`~!- , A. D. 19 l4j~ir~ ~~~~i
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My Commission expires
(To be e:ecutM in duplicste snd ori6,ina1 filed witA Ckrk Circak Court, and duplkate with Tss Apestor)
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