HomeMy WebLinkAbout1668 ~1~~:.~."~`.s~t~. C~~~ CI ~Q 1~~~::cv Gci ~ ~ic.~~ :t ~~ti`t~
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'1'O 'fl ll: S'I',~'1'I~ A\!) C'OUN'i'1' '1'AX ASSI:SSOIt,
C'UU1'1'Y, I~ l.Oltll)A:
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Tl~is is my ~Irrl;iration of l)omicilc aiiJ Citii~•n~hip in Ihr Stat: of Tlorida that 1 am filin~ ihis day in
accordancr, :~n~l in confarmity ~vitlt Scction 2'3.1?, ~lorida Stat:~trs. `
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1~vas tonncrly a Irr:il residrnt of r-~ ~ , and 1
(citr) (state)
residcd at 7~~`'~`"r~~ t.ac,-c~ . Howcvcr, I ha~~c ch~nged my domicitc to
(Sttert and Kumbcr) ~
and am and l~ave bccn a bona Cdc n~sidcnt of thc State of I=lorida sincc ~'7~-"day of
~ , 19~ and I residc at ~~!`zza~~-R<~-A~i -
J (Street snd~ mbe*)
~ic~ ~-c~.~-c~ . ~-~-s-~t ~ County, rlorida,
~ (cti~r)
and this statcmcnt is to bc taken as my declaration of citizcnsl~ip, actual legal residcncc and domicilc in the State
of Florida.
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(lnse~t here any ~+erlincnt facts, such u sale of prope~ty ot busincss, or rtlinquishmcnt oi employment al forme~
domicile. removal oi family to ne~v domicilr, purchase of home, r~c.) -
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- s7niuciE couHn oEo
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1 FURT}iGR CEItT[FY that t~~~ill rcgister at my loca! address when the registration books tcopen, and
comply with all otl~cr requi~ements of a Ic~al resident of this State.
I rURTHER CERTIf
Y that 1 have no intention to reti~rn to my fomier domicile, and I intend to rcmain in
~i~~ ~~~~e, , . '~~J , County,
Tlorida, pcrmancnUy: (~'`r) -
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S~vorn to ,ind suUscribcd bcforc mc this ~~~ay of
~ _ A.U. 19 ~'Z 6 ~'~-a~
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Nolarr 1'ul?lic Slate uf 1 I~~nJa at 1_wrKr ~J ;;('i~~ ~,r :
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My Commi~.sion cxpirrs = . v :
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(Tu 1?r c~eculrJ in duplira~r and ~~nFin~l (~1.•J ailh l'Irrk (Sy~b11't'~'u t~ anJ {~~iF~ ~11h Tsi Asarswr)
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BO~K~VS PACE1~~8 • st ' v`•~'` , ~
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