HomeMy WebLinkAbout1266 De~claration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, 229599
~ L-~~~~' COUNTY, FLORIDA:
'il~is is my declaration 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 °S~~/~(/~~ , and I
( ~er) (state)
resided at /~L R"2E~7 ~7'~ • . However, I have changed my domicile to
(SUeet snd Number) ~
and am and have been a bona fide resident of the State of Florida since day of
~v~'~~~~-° , 19~~ and I reside at CG ~eff0 ~d~=
(Str~t sad Number)
~ z~ j"/G~~F ~f L~/E County, Florida,
(c~~r) ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domiciZe in the State
of Ftorida.
~ (Insrri here any perti~ent facts, such as sak of property or businas, or relinquishmeot ot emptorment at totmer
domic~le. removd of family to new domicile, purchave ot home, etc.)
~ , c,«,~cJa,1%e.
~~~i~~~~ ~
~~R-~1T~+~
~R~ ~t~ftt Q~y~1G
9 y~FiE~fA+~i.
~r ii 3 ~PH ~T2
2~599
I FURTHER CERTIFY that I 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 CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ -~-~/r'f" ~'~~'G~E ~-f . GU Q•~E-- CountY,
, ,
Florida, permanently.
~(~ic c i~a~! G. i~-~ i ~~~.r/~
(Name)
I . .:.j~!`f .
' ~ ' ~~_+o~,. COd 4 ~L ~/'~it/~~~
. ~ - (waa~as)
: Swornyto ana~`subs~ribed before me this _i_~_ day of
r
~ A.D. 19
j . .
, ~
~ ~ rot e~nu~ s~u~ or r~ria~ a~
My Commission expires ~G ~ ~ 3
~ (To be executed in duplicate and original C~led wilh Chtk C'vcuit Court, and duplicate witA Taz Aaessot)
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