HomeMy WebLinkAbout1393 233801
Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
_~'~G~~~ _ COUNTY, FLORtDA:
This is my deciaration of D~micil~ and Citizenship in the State of Florida that I am ~ling this day in
accordance, :~nd 'en conformity with Section 222.17, Florida Statutes.
1 was formerly a legal resident of , ~~!yo~-r and I
(~tr) (sace)
nsidrd at a~~ ~o •~~?~u~ /~~~e-~. . However, I have changed my domicile to
(Street and Number)
and am and have bt:en a bona fide resident of the State of Florida since day of
, 19 7~
- and I residt at 8 ~
,
~'~~C- _ _ 1 c1 ~ (Street and Number)
. r kc'~~ County, Florida,
(c~~r)
and this statement is to be taken as my declaration of citizenship, actual tegal l~sidence and domicile in the State
of Florida.
(Inscrt hcre any pertiaent facts, such as sak of property or busi~ess, or relinquishmeat of employmmt st tormer
domicile, removal of tamily to new domicJe, purchue of home, etc.)
' ~i ~-sC-~' -
s~~~~ 233801 .
-
~iCORO YE~~ryf
~~~1
~
~
,
1 FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domicite, and I intend tu remain in
~s-7~' ~Lt ~ c~ , .s1~ O'fkc~e~ , County,
Florida, permanently. ~c;'r~
~ L „c~;; , ~ ~S?~i~~r,
: ~ • l i~ ~
,r ~
- ' ` . ~ ' (Name)
• ~ ~ ~ ~ ~ 708 ,Q /5~~.~1
_ ~ . c, -
; t . ~ 't ~ f~ 1. ~ ~ ~ ~ (naa~ess~
'~~l~ T+L
. .
~,~~vorT~,XQ ati~s~~t~iscribed before me this "2 ~ day of
~ ' ` ~ A.D. 19~--
~ a1c...~.(.!i . - i
Noury Public State ot k'brida at Large ~
My Commission expires /9~'~O . ~
,
(To be executed 'en duplicate and origenal filed with Ctetk C'vcuit Coutt, and duplicate with Tax Assessor) ~
~ t ~
. ~~04 ~i39Z ~ - - ,
~ - - _ !_X ~
_ _ .