HomeMy WebLinkAbout1227 De~claration of Domicile and Citizenship
Z295'74
TO THE S'fATE AND COUNTY TAX ASS~SSOR,
, .
-u-~-~-G COUNTY, FLORIDA:
~
This is my declaration of Domicite and Citizenship in the State of Florida that 1 am filing this day in
acconlance~and in conformity with Section 222.17, Florida Statutes.
1 was formerly a legal resident of ~ , and I
t~+cr (stu
resided at 3 a~ • . However, I have changed my domicile to
csa~t ~a rr~meK)
and am and have been a bona fide residcnt of the State of Florida since ~ s~ day of
~ , l 9
7
Y, and I reside at 1~'1~ ~7 ~o ~1 --~i-,~s~-~-w t41~/`L~
.,,o (smet .na Nameer)
~ ~ ~ • v~ ~-t~ County, Florida,
(citr) '
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(lnsen Aerc any pertinrnt facts. such as sale of propeny or business. or relinquisi?ment ot employmeat at tonaet
domic~c, rcmora! ot familr to new domic~7e, purchase of home, etc.)
~ _ .
'N.~E.T~, .l~Y~- ~ ~ •
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at° ~ C~.~~.d.o - ~ ~ .
, - ~ ~ ~zss~~
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' ~ ^ / ~ " fIlEO AIiO RECOROE~
/1 ` ~t. WCIE COUMTY Fl .
. i ~ ~ RQCER POITRAS
CLERK CiRCUtT COUpT
~ ~ _ ~i RfCORO VER~~fEO..~..~.
Nur !6 12 os PM'1Z
~
I FURTHER CERTIFY that I will register at my local address when ihe registration books reopen, and
compiy with ap other requirements of a lega! resident of this State.
' 1 FURTHER CERTIFY that I have no intention to return my ormer domicile, and I intend to remain in
~
.~-o~_ .c.t~cX~--_`_--
-y , County,
Florida, permanently. (c~er~
.
6R
~`~do
, ~ (Address)
' ; ' ~
Swpi~? ~Q:antd~ub~tc~d before me this day of
- ~ J A. D. 19 ~ ~ .
_ . .
` : ~ ~
~
~ ~ ~ Hotsr~, '&ate of Florids at e
; ~ .
f ~ ~.o~~ `~2y~a ~ o ~ 97 y
My Co~m~tbd'eXp'Ires
.
~ (To be executed in duplicate and oriEinal fded with Cktk Crcuit Court, and dupticate with Tu Atsessor)
E ~~202 ~f1227
~ • AGO fr~rm 71-22
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