HomeMy WebLinkAbout1743 Y ~
Declaratic~n of Domicile and Gitizenship
TO TtiE STATE AND COUNTY TAX ASSESSOR, 2~Q~O '
i
~T __~4c L CUUNTY, FLORIDA: ~
i
Tl~is is my declar~tion af Doniicile and Citizenship in the State of Florida that 1 am filing this day in }
!
accordan~c, and in conlorniity with Section ~??.17, Florida Statutcs. !
~ ;
1 was formerly a legal residcnt of Gf ,_~U / f f d~ S 3 and 1 ;
(ci y) / (State) ;
r~sided at 11 e~~~%¢
~_~!2!!1 . However, ! have changed my domicile to
(Strar! and Number) j
and am and have been a bona ~de resident oC the State ul Florida since _ day ot ;
l9_,~~. and 1 rrside at ~o S~ f~'c~~ /
~ ~i- , (Street and N mber) ~
, ~'e~~ ~ ~_5% l u c~ ~ County, Florida, 4
cc•~~r) ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Fiorida.
(Inseri here any prrtinrnt facts, such ac satr of pn~perty or business, or rrlinquishment of employment at torme~
domicile, removal of family to neH~ domicile, purchasr of hume, rtc.)
- i
i
~
~ ~
Sc.~ z ~3 ~ v~v f,~>.~i.vc~' ~ ~ ti ~,a f_ u -e- ~ ~3.~ _
S I
~
~ F ~ .Q ~ / "7~~~~ ~ C Li u ~~-e .l' c'~ ~ ~ ~
~7`~ ~
s~i
°u~~ c~a~.
ROCER POtTRAg ,
~Y.ERK Cir.culT COiHtT ~ ~
RECORD vERiFlEO.,~ ;
_ t
~w.16 3 03 pM'~Z ~
~
;
~
~
234040 '
1 FURTHER CERTIFY that 1 wiU rrgister at my leral 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 domicile, and i intend to remain in
fT ~.ERcE _ ------ST L~c./ , County,
Fiorida, permanently. RICH.ARD HUL S -
l~, i <<,~~t
f - _ _
~me) -
~ / .
~ G d ~ .~~3 ~ - .
,.s`". ~..t G 1 ;
- ~
~y
~~t..,~~~.,~~~..~•; . ~,'l ~-<.ltie~twaa u~
v t~t; ~ ' ~
Sworn to and sub -~bed before.-tl~~ ' ~I'~ay c~f
- :
_
ti •
- ~ s '
• •o
. v 'r? ~•r •
' ' OR~
~c tate o ~6~ ~ ~ ~ _ a~~ ~ PACE~
My Commission expires_____~~~'s,,~___$L.
~~~~a.~..r•~•
i
(To be raecuted in duplicale anJ oriKinal filyd with ('lerk Circuet Court, and duplecate with Tax Auessor)
,
~ r' .
'~r-~ ~ - - ..T.,..,.
"~'~"-~.*H~.._~.# ..~''-r~ - . ~