HomeMy WebLinkAbout2005 Declaration of Domicile and Citizenship
TU THt: STATE ANU COUNTY TAX ASSESSOR, 234253
~ _ ('OUNTY, FLORIDA:
Tl~is is my drelar:~tion ot~ Domicilc and Citizcnship in the State of Florida that 1 am tiling this day in
accordanc~, and in conformity with Section ?~2.17, Florida Statutes. .
1 was fornierly a lega! resident of ~~c° L.~_~/~'i1L - and l
r~ (citr ) (statr)
msidcd at _~~N -~_1rL__~F~ . However, 1 have changed my domicile to
(Street and Numbtr)
and am a~id havr bcen a bona fide msidrnt of the State of Florida since day of
- /q . 19 and I reside atc~%~e~~l.v t~osa °~N ~;dol ---1----
~ / -
l_,~~ ~~.~hst~~~--------. ~ t~~. County. Florida,
- ~c~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(inseri herr any prrlinent facts, such as sale of property or business, or relinyuishment of rmployment at tormer
domicile, removal of f~mily to ne~v domicile, purchase of home, rtc.)
. r
~.x~-~.-
~ • ' :
_
. ~ ~ ~~d~?~ .
. ~ ~
- ~>~j~~~ ~ ~O ~ 234~3
~
~ 5 ' ~J 0 AMO RECORp~
=~itC1E COUNTT Fl~ `
IlOCER POITRAt
OLEfIK CIRCUIT COURT
~ RECORD YERIFIEO~,.,~,,,,~~
~ te ~ 3z ~N •~z
~ ~
~
~
~
;
1 FURTHER CERTtF~' that I will register at my loral address when the rcgistration books reopen, and !
i
comply with all other requirements ot~ a legal resident of this State. :
~
i
1 FURTHER CERTIFY that 1 have no intention to return to my fom~er domicile, and I intend to remain in ~
/ _ ~
~i2~ 1i_C.C i C..-------------• ~G C ~ C~ ('ounty. ~
tc~~. ? °
Florida, pern~anrntly. ~
, ;
~ •~'~~~Q i? ~O~''~. - - - ~ _~~~e._.- .
:i c~ ~"'1~ =
: . / _
~ i ~ ~t t . b~ ~~a?C 05~'~ .C i~ c . t~~_ ~~A _ ~
~ = ~ ' ' . ~Address) ;
. ~ ~ s ;
•
I= ~`toal~~s ~ ed befare me this day of
'•~(i~; ~ O. ~ -
E C A. D. 19 ~-Z .
- . ~ . :
~~a~~~ _c~.~~Q/ ~ ~
. ~
~s~
tity Commission cxpires----_- - - ~.r~~s~ ~~Bt.(~ `
(Tu t+e esrcuted in duplicate and uriginal filyd wilh Cletk Citcuit Court, and duplicate with Tax Asxessot)
~
~^V~~~
1i, ~
- - ,,.,s ~
_ z ~ ~
~ ~ ' ' ``~'~s„` ,
~ .i'~' =~'~at i~ -=~i*'.+~^R- a ro"~°"~ -
s ~ ~ Sa~ : .