HomeMy WebLinkAbout2006 Declaration of DomicilQ and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~QQB'7
`
COUNTY, FLORIDA:
Tiiis is my d~claration of Domicite and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformity with Seetion 222.17, Florida Statutes.
1 was formerly a legal resident of , ~ • a~d t
(Citr1 ( te)
resided at ~ ~ . However, I have changed my domicile to
(St~eet Number)
and am and have bcen a bona fide resident of the State of Florida since day of
, l 9~ and 1 reside at ~ 7~ Sf' _
_ s^`'.~-~ treet and Numbet)
. ~ ~ County, Florida,
( ~Y)
and this statement is to be taken as my declaration of citizenship, actual Iegal residence and domicile in the State
of Flonda.
(Insert here anr pettinent facts, such as sale of property or business, or relioquishment of employment at tormer
domicile, removal of tamily to ~ew domicile, purchsse of home, etc.)
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REC~Rp YERtP1Ep„~~GA
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1 FURTHER CERTIFY that I will register ai my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHE ERTIFY that 1 have no intention to return to my former domicile, and 1 intend to remain in
~ • ~ i
~GY~' ~t~c~t'_,c,t , COUIIiy, ~
Florida, permanently. «"y~ ~
'
r (Name)
cS ~7 ;?2 1 e 7 ~c • S
r
(Aadress)
Sworn to and subscribed before me this day of .
,;~r~,,,
A A. D. 19
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~ RY~iC State of Plorida rge
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My;~~
rofitm~s ~
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~ ~ , '~si~~y~~', ~.~~'Y •
,_t~:~.;; ; j~!~'r,~~.~'4 ~e e:ecuted in duplicate and originai filed w~th Cferk Crccuit Court, and duplicale with Tax Assessor)
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6001(~~ PAGE~VO~
qr,p I•~rm ?1-22
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