HomeMy WebLinkAbout1262 Declaration of Domicile and Citiienship
TO THE STATE ANU C'OUNTY TAX ASSESSOR,
-~T_. ~Lr~tJE_____ C'OUNTY, FLORIDA: ~316`~Q '
This is my declaration of Domicile and Citizenship in th~ Stat~ of Florida that 1 am filing this day in
arcordancr, and in conlorn~ity with Section ~??.17, Florida Statutes.
1 was formerly a icgal rcsident of
_---~~Q_~~ .,~O4Tff ~~iPe•C~.ti~nd t
(CifY (Stslej
rc;sidcd at ~!s2__~~~5~_ _S r . Howc~ver, I have changed my domicile to
(Sireet and NJmbrr) ~
and am and have bc~c~~ a bona fide residcnt of the State of Florida since ~ r day of
---_J
CL_NE----,__ . 19 ~
Y- and 1 reside at '"/D AR D~.t//~ /S~GG
l (Street and Numbet)
_~.~1~__~ -~C~ _ , s T. GL ~ / J~ ~ County, Florida,
(CitY1
and this statement is to be taken as my dectaration of citizenship, actual tegal residence and domicile in the State
of Florida.
(inseri herr any ~tinrnt facts, such as ssle ot propertp or businrss, or relinquis!?ment of employment at tormer
domicile, removal of family to new Jomicile, purchase of homr, rtc l
I am currently on duty with the U. S. Army stationed
_ at Redstone Arsnel, Alabama; however upon my retirement
I shall be pecme n~ly at the above stated address .
FtLED t~~o a~~~~~~
SS+~GEFyP 1t
CLERK C! ~ZCUtj COV4;-
ICF CoRO f nt F{E ~1- _~1"._:-.-~ =
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S~ ~I• I lr• V
231650
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1 FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and ~
comply with all other requirements of a le~:al rrsident of this State.
I FURTHER CERTIFY that [ ha~~e no int~ntion to return to my torn~er domicite, and I intend to remain in
s~ ~1-C-t C_ _ ~ - - - S%; 6l C County,
Florida, perm:~ner~tly ~c~u~?
v_/_ /1 - -
IName? ~
_G$Q~foR D D D~'~-----
(Addressl
~ / ~i EpSTOn~~~~S~~A~ i9.C~
Sw~rn to ;~nd suhscribed bcforc me this f(P day of /
- - - A.D. I9 ~ . : ;~~,<;~c:s~ir~~ J 5~~~
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.~j r' _ ~ `~r=1%;
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uury blic State of flunda at ¢e r:^'' "
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1~1y Commission c~pires - - - - ' '
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!Tu br r~ecutrd ~n duplwate rnJ unKmal (~Ird wilh l'Ieri.G~cYit'Cpyjj~~IK91t Nllll Tix Assesscx)
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