HomeMy WebLinkAbout2259 234431
Declaration of Domicile and Citizenship
"I'O Tt E STATE ANU COUNTY TAX ASSESSOR,
.
_ ('OUNTY, F=LORIDA:
Ti~is is my drelaration ot' Uomicilr ancl Citi-r.rnship in the Stat~ of
Ftorida that l am filing this day in
a~cordanrc, and in ronl'ormity with Sertion _"_?.17, Florida Statutrs.
;
1 was fom~crly a Irgal residrnt of . _ _ _ - • ---L~'-~-iti~ and I !
tc~~r) (s `
rrsidrd at - ~ - - . However, I have changed my domicile to
(Strert and Number) ~
and am and have brrn a bona fide resident of the State of Florida since day of
- -~2~'__--~--- . l~-, and 1 rrsidr at ~Y
~ IStreet and Number)
------~J~~ Q~t~t.~ - -~~~it~c~~- County, Florida,
(c~~>•)
~nd this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. -
(Insrri hrre any prrtinrnt facls, such as salr of proprrtY ur businru, or rrlinquishment oi employmrnt at former ~
domicJe, removal uf tamily 1o nr~~ domicdr, purchase ut homr, rtc.)
. ~
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234431
fILEO ANO RECQR~Ep p
ST.lUC1E COUNtY flA.
ROGER POIIRAS
CLERK CiRCUtT COURT
RECORD YERIFIEO~.~ ;
Arc I 3 eo PH'12 ~
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1 FURTHER CERTIFY that 1 will recister at my loral address when the registration books rcop~n, and ;
comply with :~ll other requirements of a le~al resident of this State. f
,
I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and 1 intend to remain in i
.
• , Count =
. ` :~-1--oC ;
- y• t
Florida, ~ermanently. x
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~ ,n ` ~ (Addresc) ~
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"~$~ro~n.to apd,subs~:~iibed brfom me this day of ~
- - - - - - A.U. 19 s
. i
- C~?~ - - ~t ~ '
~nJa at l.ar~:r Cl~.~,itc. Ct tt~cc7
~
~1y Commission cxpires - _ - - -
~ (To be rxrcutrJ in dup6ratr and unKinal (ilyd Nith Cletk ('ircuit Courl, and Juplicatr with Tax Assessot)
~ . ao~ 204 PN~t 2258 ~ . : - ,
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