HomeMy WebLinkAbout2535 Declaration of Donnicise and C~titenship
TO TH~ STAT~ ANU COUNTY TAX ASSESSOR, -
. '
_ _ COUNTY, FLORIDA:
Tiiis is my decl:~ration of Domicile and Citizenship in the State of Fiorida that l am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
1 was formerly a legal resident of i/ ~and I
t~~r> (St•te)
nsided at ~ . However, I have changed my domicile to
(Street and Num er)
and am and have been a bona fide resident of the State of Florida since ~ day of
, 19_~~-and 1 reside at L~ •
~ ,~.~~~,,.~(Sueet and Nuuiber)
~Z~C`-r
~-f~ ~~~-J . . ~ .~T~ ~ r'-~~-~ County, Fiorida,
(~~r)
and this statement is to be taken as my declaration of citizenship, actual lega! residence and domicile in the State
of Florida.
(lnserl here anr perlincnt f~cts, such ss sak ot ptoperty or busineu, or relinquishment of employment at fotmer
domicile, ~emoral of familr to new domicile, pwchsss of home, etc.)
.
~ . .
' l/ ~I"Y~ ?~y~
fy,~0 AND IlE~pBN0
ST.~E~
Pa~iTR~~fIA. ~
CLERK CI`tCUtT CO~RT ~
RECORO VER~FlED~
M~r ~ ~ 0~ PM'~Z
~386 ~
1 FURTHER CERTIFY that I wiQ register at my loc;al 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
,
~ ~!let~~ ~,L~P/~~l'~ , _.~~s~.` l~~C~d-0 ~ , County.
Florida, permanently. cc~~r~ '
( ame) -
'`~7 9.~QiliG~CCL
IAddress) T~~'•`----
. . ~ ' . •~r~ :
Sworn Lo and subscribed before me this day of .
, . • ;
- A.D. 19??-. ,y
- - . . : u~,
- - .:~_it
-
- . • ~
NotuY ~bNc State of Fiorids at Lar6t ~ ~ " _ : ; ~ , '
My Commission expires- ~
,0
(To be eaecuted in duplicate anJ on~inal fited wilh Cltrle Citcup Court, ~nd duplicsle witb Tsx Aue~so~)
~t~R ~iV1 ~f ICri~wl.r A ~ ,
~
~.~,~;z :
R~ j - .
~ 5~'_
~'3`
~e