HomeMy WebLinkAbout2633 Declaration o~ Domici~a and Citizen~p
TO THE STATE Ann r~UNTY TAX ASSESSOR, . ~4'~3 ~ t
_ COUNTY, F[.ORiDA:
This is my d~claration 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.
1 was formerly a legal resident of C~ L E N V~ E W ~ L ~ N ~ ~ S and I
.Z,OOD V~~tU K ECcRN 1~ORD -~.oTr~ ~ 0 ~S~~~e~
residcd at _ . However, I have changed my domicile to
(Street and Number)
and am and have been a bona fide resident of the State ~ of Florida since day of
__L~1 6 ~ Cm D eir , 19~ and 1 reside at l1~oD RESeRT.~ pf MERICA NETT ES 1Sl.~1~D
(Street and Number)
,~~.~i~~, T~ ER~_, ~~41 L~ T~,,, G 1 E County, Florida,
(city)
and this statement is to be taken as my declaration of citizenship, actual Iegal residence and domicile in the State
of Florida.
(tnxrt here any pertinent tacts, such as sak of propertr or business, ot relinquishment of employment at tormer
domicile, removal of family to new domicile, purchase ot home, etc.)
~fa,~~s~, ~~i ZeO~~t~,1,cv ` ` .
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y
f LEO AND f
j~ ICIOCER~PO~ITRA~
CLERK CiRCUIT COtIR
RECORO V~RIfIF
. Miur 1 1016 ~~j
2284'73
1 FURTHER CERTIFY 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.
1 FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~~TTLE S~~,,~tlD ~OR T~! E R CE I 1 County,
!T'r:, (CitY) . ~
Florida, permane~S~yh. ~,~~.r!-~t,~/ _ /Qs=,
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Sword~tp ~~~su83~t't~~d before me this ~ day of . 1ti ~PC.~i
~ f ~ t ~ , --T
_ Q A.D. 192~- l uii~r
~ ~ ~
' Notuy Public State oi Elorids at Lat6e
My Commission expires ~ 6001(~rV~ PAfE~,;,VJV
(To be e:ecuted in duplicate and uriEinal fiied with Clerk Circuit Court, and duplicate with Tu Af~esfw)
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