HomeMy WebLinkAbout2414 Dedaration of Domicile and itizen
C shtp
TO TNE STATE AND COUNTY TAX ASSESSOR,
L C i'~ COUNTY, FLORIDA: ~ ~303
~
This is my ds~claration of Domicile and Citizenship i~ 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 ~/A°/17/~/~' i/!? ~/Q/•
~~~r~ , and 1
(State)
resided at /~t ~.l ~~N~ . However, I have changed my domicile to
(Street and Numbe?)
and am and have been a bona tide ~esident of the State of Florida since a G day of
_ , 19~ and 1 reside at e e ~ A ~~S ~ ~
. (Street aad 1Vumber)
O~^"1 i Q 1^ C s-- , S'~' • 1- U C County, F lorida,
(c~ir) ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(I~seri here any pertinent fscts, sucb as sale of property or businas, or relinquishmeat of employmeat at tormet
domic~7e. removai ot family to new domicile, purcdase ot home, etc.)
~1'l e I o d ~ s m
C ~~~d e_ L- Sm~t~j
~ F LEp AMD BEC~R~q
i~.ltJC1E COUN ru~.
. IIOCER POITRAS
CIERK Ct(iCUiT COIMt
NECORO YERIf1EG '
Ib~r I 8 ~N'?2
2~83t33 . ~
,
,
i
1 FURTHER CERTIF.Y that 1 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 CE IFY that I have no intention to return to my former domic' e, and 1 intend to remain in
. ~ .
~ ~ , County, {
Florida, permanently. cc~~y> ~
, .
me)
(Address)
Sworn to nd subscribed before me this da of .
y .1~tttlt:Nlk~jl~
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A.D. 19~1L ~ N....~j,)~'%,; .
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` arr lic State of blorids st Lar~te `.~;,f,~~''~ "
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My Commission expires--~ ` ' f' ~ ` "
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(To be eaecutM in duplics~e and wi~inal t~led vrith Ckrk Cirt~M Co~ut, and dYplks~e w~itM T~: AMe~sor)
aa~ 201 n~c~241,1
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