HomeMy WebLinkAbout1384 Declaratian of Domicile and Citizenship
TO THE STATE D COUNTY TAX ASSESSOR, 2i~~''
.
_ COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
accordancc, and in conformity with Section 222.17, Florida Statutcs,
.
I was formerly a legal ~sident of ' , and I
(citr) . ate)
r~sided at~~ . However, 1 have c nged my domicile to
(Strcet and Numbct)
and am and have been a bona fide resident of the State of Florida since y o1
~
~ , 19 and 1 resid~ at .
~ treet artd Number)
~ /il~~'J
- . - County, Florida,
(c~tr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Fiorida.
(Irtscri here any ~xrtinent facis, such u sale of property or business, or ~elinquishment ot employment at former
domicile, removal ot tamily to new domicile, purchase of home, rtc.)
i
~
~~~A~MO RE ~
CIERI
~~R POt
~ AECORD v~iFjEO
2'~ ~Z o~ PN'lt
2~~z
I FURTHER CERTIFY that t 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 at I have no intention to return to my former d micile, and I intend to remain in
.
~GrC-F? , ~ , County,
Flonda, permanenily. ~c'tY~
Name)
(Address) ,
'iitl r~Y..
Sworn to 6~ ubscribed before me this °'Z~ day of
ti r
_
~
A. D. 19~~~
:
~ z ` ~oW bUc Statt of florida at Large e~
. _ ~ _
ovew
~MY~4lllc~sic~~xpires ~
1~i r-
• ' (To be executed io duplicate and originel fdrd with Clerk Circuit Court, and duplicate with Tax As.ussor)
i , •
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