HomeMy WebLinkAbout2640 Deciaration of Domicile and Citizenship
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TU THI: STATF; ANU ('OUNTY TAX ASSE:SSOR.
~L~~~-~-~- CUUNTY, FLORIUA~ ;
Thi~ is my dcrlaration c?1' Uomicilr .in~! Citizrnship in thc Stutc of Florida that l am filing this day in
arcos~anc~, anci in cont~ormity with Section ~'?.17. Florida Statutrs.
- - - , ~jLC_- G"`'i`-'--- and 1
1 was t~ornuriy • r~al nsid~~~t ot~-~- - - - -
l('itY) ~e1
rrsi~i~d at ' gj _ - - _ _ - - - - . However. I have changed my domicile to
(Sirrrt anJ Numher? ~
and am and havr 5~;n a bona ti~le rrsidrnt of thc St~t~ ui' Florida sincc day of
~ /'f 5~ -~n~rtc.rs.au- ~U'~
- - - t~.ltl~~ • 1 - • an~t I rrsidc at ~ ' _ - ~~1~-----
c'~s -
, / (Street and Number)
~ ~„Q~,~ _ --~-~c'-~-~~ County, Florida,
~ - - - . ~
(Cil. )
and this statemrnt is to b~ takrn as iny dcclaration of cit~zenship, artual legal residence and domicile in the State
uf Florida.
(Insrri herc ~m prrtinrnt fact~, such as wlr uf pruprrty or businrss, ur rrlinyuishment of rmployment at tormet
domicilr, rrmu~al uf famih• t~~ nr~c Jomic~lr, purchasr of homr. rtc.l
_ ~
~4124'7
F LEO ~MQ IiECQRQEO
S~. LUCIE COUNrtr F~A.
ROC~ F r~iTRAS
CLfRK CI~CUIT COURT
RECCRL' YEfisFtED~.,~.,,. ~
Noy 2 3 wS PH'11
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1 FURTHER CERTIFI~ that 1 w:ll rr~ister at rny loral address when the registration books reop~n, and
romply with all othrr requirements c~t a Ic.~al r~sident of this Statr.
I FURTHER CERTIFY that I ha~•~ ne? intentirni to return to my fornie domicilc, and I intend to remain in
- Q • --u-~C~C.
~/l- / .~c..e~tG~i . ' Co«nty.
F1oY~cla~{iF.fm~nently. - -rc~~.? .
_ ~ ? • ~ i?~
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~ = Ha olu ~ e`~~
' , U 3 L ~ G . - - -
~ " ~ (.triwssl
~ ~st . . • •e
~~~wdr~Rb~~}~siibscribed before me thi; day of
,
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°`~'t'~ _ _ . A.U. 1
- - - ~c-.~.c~ ~
/ ~i
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Notar • ublic State of E7unJa at Lar~:.
ti1y Commission espires_ _~u~_'.
(To br e~rcutrd in dupGcale and un~inal filyd ~~ith Clrrk ('ircuit Cuurt, anJ duplicate with Tax Assessor)
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