HomeMy WebLinkAbout1673 Declaration of Domicile and Citizenship
229841
TO THE STAT~AND COUNTY TAX ASSESSOR,
_ COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in ihe 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 ~4.0.0 `
, and I
(~ti~r) (sace)
resided at .~Z , ~ . However, I have changed my domicile to
(St~eet and Numbe~) ~
and am and have been a bona fide resident of the State of Florida since ~ day of
, 19 ~ arnd 1 reside at ~ ~
~ (sa~e~.Qa mee~)
. . 1'y6'"`~'•
. ,~.a~ County, Florida,
(c~ir)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert here any pertinent hcts, sucA as sale ot property or buciRas, or relinquishment of employmmt at former
domic~e, temoval of famiiy to new domicile~ putchsse ot Aome, etc.)
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2~841
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I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and ~
comply with au other requirements of a legal resident of this State.
1 FU/R~THER CERTIFY that ! have no intention to return to my former domicile, and I it?tend to remain in
` ~ . I.DUnil f
Florida, permanentty. «''Y> '
_ ~ 01~~~~~
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Sworn to and subscribed before me this Z' day of
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f.
A. D. 19 . ~ ' . , = ^ .
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Notu Wie State of fbrids al 6e _ , ~
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My Commission erpires ~ ' l~ " ~ ~ . ~
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(To be executed in duplicate and ori6inal filed wiiM C(6tlr,Yqre~dl;Csqrrt; iMD duplicate with Tax Assessor)
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