HomeMy WebLinkAbout1768 N~
De~cfaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, '~s~
~ ~
~ _ CUUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accorciance, and in conformity with Section 222.17, Florida Statutes.
1 was formerly a legal resident of _~~•tr and I
~ (ci~r) (si ce)
resided at o707 I~f~7~~{j'j~G/T,~A/ DYAL- . However, I have changed my domicile to
(St~cet and Number)
and am and have been a bona fide resident of the State of Florida since - day of
.
, 191~y and 1 reside at ~~a7 ,~~L o~ ~d 3'- ~v
(Street and Number)
~J" ~E L' E~L/1~~ w~
~~?T. 57 ~ L vC?~ County, Florida,
(c~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(lnutt Aerc any pertinent facts, sucb ss sale of property ot business. or relinquithment of employmeM at tormer
domic~e. removal of familr to new domicile, purc6sse of home. etc.)
~ ~ ~
V~ ~ ~iO~~I~~~~
IIOCER PORIl~i
c~ERK c~~cv~T couRT ~
RECOAO VERIfIEO
N~r 11 3 zz PM'Tt
229~91.1
1 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 t at I have no intention to return to my former domic' e, and I intend to remain in
. ' r. ~f . ~~lh~i C..e'
_ " , COUilty,
~~'da~ (ci~r)
r
? -
~ ~ i :
- . •9 _
Abrahea Grossma~`i""`~
} . - ~.j,~.'-.
~ ~ . Be~L~- 76 3 - 51J FT IiE,PcE
~ ~ : . (waa~sf
Sworn to and subscribed before me this °~1 day ot'
- ~ A.D.19~z-'.
,
` ~~,~-~c-~
;
; r~b1ic stst ot Eloriaa at Larae
; ~Ntr ~ue~ic, sT~r~ or F~aRia+~ a tutcE
I My Commission exp'ves ~1' ~
THIN GENERAL INSURAtICE UhuEItWRl~
I (To be exeruted in dupiicste and oriainsl filed Nith Clrtk C~cuN Court, snd duplicste with Tu Assessor)
80~K~~ PACf~~~ Ac:<> ;
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