HomeMy WebLinkAbout1335 ~•N
. Declaration of Domicile and Citizenship
TO T E STAT AND COUNTY TAX ASSESSOR, ~3~J~
''~~-LL COUNTY, FLORIDA:
"Il~is is my dcclaration of Domicile and Citizenship in the State of Florida that [ am Giing this day in
accordance, and in conformity with Section 222.17, Ftorida Statutes.
I was formeriy a legal resident of - S rn 7 n~ T , ~ and 1
~ city) (state)
resided at J IJJ ~ A n1 D.R. u m __~1,) . However, I have changed my domicile to
(Stteet and Numberl
and am and have been a bona fide resident of the State of Florida since day of
, I9~, and I residc at ~7~ o ~L Q SSa ~ (r .
^ ` ~ C ~ ti (Strcet aad Number)
C.. , .S l. L! G~ ~ County, Florida,
(citr) - -
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Inscrt here any pevtinent facts, such as sale of property or bus~, ix relinquishment of employment at totmer
domicile~ removai of family to ~ew domicite, purcAase of home, etc.)
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
~ comply with all other reguirements of a legal resident of this State.
i 1 FURTHE E•RTIFY that I have no intention to return to my former do icile, and I intend to remain in
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; -~C..Q.J~!'-'~~ , , County,
~ Florida, permanently, cc~cy~
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.5^wqr~?: to ~a ~ s~t~cribed before me this~~_ day of
~ - . .
; A.D. 197 ~ .
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~ Notuy Public State ot Florida at lar6e
; HO~ARY PU8!!C, STATE of F10RIDiA ~t [AQGE
; My Commission expires Mv ~R,~+~~-~r:N ~~~s.,~ 19T6
80ftDEA ~i1RU GE1'IERAL INSUBANCE UNI?ERWRiTEfl~
~ (To be executed in dupiicate and original fJed with Clak C"vcuit Coutt, anQ duplicate with Tu Assessot)
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