HomeMy WebLinkAbout2203 Declaration of Domicile and Citizenship ~~4Q
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T() TIIF. STATI: A1D (:OUNTY TA?C ASSESSOR,
S A~h?T _ I v c~~___ COUNTY, FI.ORIDA:
71~is is my dccl.uatiau u( ll~~micilc anJ Citize~~lup in the State of Florida that 1 am filing this day in accord-
ance, and in eonforn~ih• ~~•ith Section '.,??.17, Florida Statutes. •
1~ti•as forntcrly a li~gal msidcnt of E;s
~1~~ L v~c ~ O 2+~
( City ) . ~ ( Stace )
and I resided at _~Q~ _ o O~et _~A~i~. _ . However, I have changed my domicile
( Street and Number )
to and am and ha~•u hcen a honu fide resident of ihe State of Florida since ~'~c--~~
5'~~ day of
_ - . ~ ~ ~__0 4E ~ 19_~, aad I reside at S a ~ ov ? v~a. ~E/t'R
( Street and Numba )
_ P-.~~,.;,-- ~_~!~!r3 ~--~i~-- ~~~~?r L uc~r County, Florida,
l C~b• )
au~l this statcmrnt is to be tal:en as my derlaration of citizcnsl~ip, actual legal residence and domicile in the State
of Florida.
( Inscrt here any pertinent Eacts, such as sale of property or business. or relinc~uishment of anpbyanent at
(ormer domicile, removal of f aznily to new domicile, purchase of home, etc. )
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I FURTHEI~ CERTIF'Y that I will register.at my local addreu when the registration books reopen, and
couipl~~ ~vith all od~er requiremcnis of a legal resident of this State.
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~~~~~~B,TEiER I;F.RT1F'Y that I have no intention to return to my former domicile, and I intend to re~nain in
' •~n
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' • ~~p~n~ A L.~ c , ;S A \ NT _ COllIlty, Florida,
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- -~~~FF~,.•• ~ ~dayof
~Swoni, ~,o ~a7Ail sul~scribecl before me this
~m b e r , A. D. 1~~ ~ Ii,w.~~ t' Vl s,~y
Fr~dt.+~~~c 1~'~. ~eri+~° /L
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G Notary Publ~c State of at Lrge
'.Ny Commission expires T,.~ ~ l~'
(To be e:ecvted in duplicate and original filod with C1ark C•ircuit C.wzt, ~eid dupliate witL Tat Astesror)
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