HomeMy WebLinkAbout2804 Dectaration of Domiciie and Citizenship
"TO 'THt: STATE ANU COUNTY 7'AX ASSESSOR, 241360
.
COUNTY, FLORtDA:
Tiiis i~ my declaralion uf Domicile and Citizen~hip in the State of Florida that I am filing this day in
accor~lanrr, :~nd in confonnity witlt Se~tion '_'?.17, Fiorida Statutcs. +
1 was formerly a Icgat resid~nt ot~~'-~F- • _ and I
(CitY) (State)
rcsided ~t ~
- . However, 1 have changed my domicile to
(Strert ~J Numt+rr) ~
and am and have becn a bona tide r~sid~~~~t of the State of Florida since _s~ day of '
:
• 19_7~ and 1 n~side at ~~~~1-__,~..C'ti~?'~-t~ '
`c~~L,~ / ' (Street and Num et) ~
-r-f-~~~~!I~°~ - - - - ~ County, Florida, `
^ - ~
tr;~, ~ ~
. ~
and this statement is to be tak~ n as my derlaration of citizenship, actual legal residence and domicile in the State ~
oi Florida. ~
1
(Insrt~ herr any pertinent factc, such as sale of proprrty or busiorss, ur relinyuishment of employment at former ~
domicile, remo~al uf family to nrN~ Jomiriie, purchasr of home, rtc.) ~ ~
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f
' f!«0 aNp RECORDED
sr~ tUCIE COUNTY pu
~cC RCUIT C URt
RECORO V~RiF~£D.,~~
Nor 6 9 e6 AN'11
, 2g~36
0
1 FURTHER CERTIFY tl~at I will r~gister at my local address whrn the registration bo~ks rco~en, and
comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I ha~~c nc~ intention to return to my forn~e domicile, and 1 intend to remain in
r
' ' ~ :
--'~~J~C~___ - - - - - - • ~A~~ County.
Florida. ermanent y_ ~r'~'~
L../ - -
(Name) p C ~Ll ~
` ` e
. ~ -Z- .6~
(Address) ~
~
Sworn to an '~bscn`~hd,beforr me thi; ~ay ot~ i
• ~ . .
~
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- - ~t"~~-~~=-~:~~:-- - A.D. 19 ~i_.i
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C' . ` /~tar~ P $t ~d Flo ' a at Lar~e ~ ~Y ~b~~ ~
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My cori,,i~'t~stot'~~~t~j~e's~;~ - - _ _
. ; . ~-ib-7.3 :
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,'~~~~~«~1~0'tl?~rzeeuted in duplicatr anJ ori~ein:~l tilyd ~vith Clerk Circuil Court, ar+d duplicate with Tax Assessor) #
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