HomeMy WebLinkAbout2632 ~ ~ .
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TO TNE STATE AND COUNTY TAY ASSESSOR, . ~4~+
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~ COUNTY. F1.ORIDA: .
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am ftling this day in
accordance, and in conformity with Section 2 17, Florida Statutes.
1 was formerly a legal id nt of ~G~ and I
tr) ' (stste).
r~sided at ~ ~ . However, I have c~nge~~y domicile to
~ (Street aod NawEer) ' ~
and am and have been a b~ry~ fide resident of th Stat f since ~ day o
, 19 d I reside at
and Num
- ~~'i County, Florida,
,
as~ ~ (cur) .p -
and this statement ' t taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. '
(ln~ett Aae aay pertineat facts, such as sale of property or busi~, ot re4iuquithmeat of employmeat at iurmet
domicle, removal of family to new domicile, putchsse ot home. etc.)
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1?ERIFIED
~ 1 ~p 16 ~'Tt
~84~2 - ~
I FLJRTHER CERTIFY that I will register at my local address when the registratiQn books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I. have nv-intention to return to my former domicile, and I intend to remain in
, County,
Florida, permanently. ~~'t''~
(N•
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Sworn to and subscribed bgfo~t~
itti~~~~,~-~,day of ~
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NotsrY Pubtic StatE o~ ' ;
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--~s~= ~~.J.i~` 60~~ P~E~
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My Commission expires- ~ ~ '-~tt-~~,~
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(To be esecuted in duplicate snd oti~inal fied with Clerk Circuit Court, aad duplicate witl~ Tau Aw~or) _
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