HomeMy WebLinkAbout0438 . y ~
Declaration of Domicile and Citiaenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~3~584 ~
~
_~r~. ~ _ COUNTY, FLORIDA: ~
,
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in °
~
accordance, and in conformity with Section 2'2.17, Florida Statutes. +
1 was formerly a lega) resident of ` and 1 ~
(CitY) (Sta
resided at _ 3 ~~C-_.t~_•~~•~ _ . However, [ have changed my domiciie to
iStreet and Numbrr)
and am and have been a bona lidc residcnt of the State af Florida since ~ day of
F , 19_']_1_, and 1 reside at
, (Street aod Number)
_ •
- , _ ~.-~L County, Fiorida, `
(c~~y)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(lnseri here any pertinrnt facts, such ac sair ot property or businrss, or relinquishment of emptoyment at former
domecile, removal of famiiy to new domicile, purchase of home, rtc J
;
ST
LUC E COUNTYAF~A,
ROCER POITRAS ~
. . CIERK C~RCWt C~URT
RECOR~ vEn~FiEO
` S~ T 9 3s AN'7,~
~3'~~g,~
~
~
~
t
~
;
1 FURTHER CERTIFY that 1 will register ai my local address when the registration books reopen, and ~
comply with :tll 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 ;
~'o2~Z !
".Ceit.c,s.~ `
~ ~ ~`.e~ , County,
Florida, permanentiy. «'`y~
\ - - (Na e) ~ ~
7 fOiTFAR.A~vb'9It1 £AT i f/Ah•iT H GR k ES ~
~ (Addr ss~ i
Sworn to and subscribed before me this day of ~
A. D. 19 ~
• ' ~
_ : . ~ w~q~qwmirin~uu~~nnrwnia~w~wr ~
~ ' Notary PubGc State of UFFICiAL SEAL ~
; ~ . ~ " . CLARA M. STEINHOFF ' ~
~ / / ~ ~/Ji ~ NOTARV PU6LIC - CJ?LIFORNIA ~ ~
My Commission expires - t COUNTY OF A~AMEDA ~
. t-- = r~ w~.assw. c.~u« wRn ~e~. i
j : l~tMM~mtNenMH~rw~muu~sn~~=~e~n.nrnnnrri~
~ (To be executed in duplicate and origin•r! l8ed with Clerk CecuA Court, and duplicale with Taa Assessor)
I ` - -
~
. . . ~ B~aK 206 ~A~E 437
~ ~ - ~
_ .
1 14{~1Y