HomeMy WebLinkAbout2032 2342'72
Declaration of Domicile and Citizenship
:
TO THt: STATt: ANU COUNTY TAX ASSI:SSOR,
__L.uG~ ~ ~•UUNTY, FLORIDA:
Tl~is is my drelaration ol~ Domirilr and Citir.~nship in the State ot' Florida that l am iiling this day in
accor~lancc, and in conformity with Sc.•rtion '_".17, Florida Statutes.
1 was I~orn~~rly a Icga! rrsia~nt of ~~v.~-` ~~~l~ -C~-~'------------ and 1 i
/ (u~r ) (s~atr J :
r~si~lyd at / _ _ G-0 - - . Hawe~~cr. 1 have changed my domicil~ to ;
(Slrrrt and NumAr~) ~
;,nd am and havc bcen a bona lide rrsident ot~ th~ St~~t~ ot~ Florida since ~a day ot
`-_~~'~-_1%~-- - . 19.7~~ an~l 1 re,ide at /~QZ~-- - ~ _?L~~%
~ (Street and Numbet)
. :~~'_'2I ~C~4.C~~-- - - - • --~~I~ County. Florida,
- - - (c•it,~ )
and this statement is to be takrn as my dcrlaration of citizcnship, actual legal residence and domicile in the State
of Florida.
(Insrr~ hrrr any prrtinrnt f~cts, ~uch u sale uf pruprrty or businrss, or relinyuishment of rmpioyment at former
domicile, remo~al of famil~~ tn ne~~ dumicilr, purchase of humr, etc.)
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fIlEO ANO RECORQEO
ST. LtIC1E GOUN'rY FU.
IlOGER POITRAS
CIERK CihCU1T COURT
RECORD VfFIFIED~....~~
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~ 1 Fl1RTHER CERTIFY that I will mRi~tcr at my lar~l address ~vhrn the registration books reopen. an~1
~ com~~ly with :~ll other requirements of a legal r~sid~nt of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my forn~er do icile, and I intcnd to remain in
` ` ~ - ` . Count~~.
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Ftorida,.pern~anently_
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~ Swor~t to ~nd subs~ribed befor~ me this °~o _ ela~~ of
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Nutary Public Sta[e uf Flunda at Lar~c
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~ (To be rarcuted in duplicatr and uri~.mal (ilyd Nith ('Ittk Circuit Courl. and dupl~cate v~ith Tas Assessor)
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