HomeMy WebLinkAbout2853 Declaration of Domicile and Citizenship .
TO THt: STAT ~ Nll COUNTY TAa ASSESSOR. 241396
<~~G~ ~
_~-L C'OUNTY, FLORIDA:
Tliis is my decl:~ration ol~ Domicilc and Citizenship in the State of Florida that 1 am filing this day in
accordancc, anJ in conCormity with Section 22?.17, Florida Statutes. 1
! was formerly a legal resident oi' -y~f~ D- p ~ and 1
lcity), (st te)
r~sidrd at _ ~O ~ - ~?D~c-°i 7'`ON e e ~i
_ . Howc:ver, I have changed my domicile to
(Strrrt and Numbrr)
~iid am and have bern , a bona tide resident of the State of Florida since day of
NO J ei?%1~~.Q---- • 19_7~ , and 1 residr at /~v-~-- ~t~ ~JlS o•~ /Q d C~'.
(Street and Number)
~o.e ~~_,~s~c ~ ~ S 7~. ~de i E Gounty, Fiorida,
(c•~~y?
and this statemrnt is to br takrn as my dcclaration of citizenship, actuat legal residence and domicile in the State
of Florida.
~1nser~ hrrr any prrlinznt tacls, such as sale of proprrly or business, or relinyuishment of employmem at tormer
dumicJe, remura! uf famiir to neK• domicile. purchase of home, rtc_)
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st lucrE
pas;~ Fs~kir i~.
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241396
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t FURTHER CERT(FY that I wili register at my local address when the regisiration boohs reopen, and
i cumply with ali other requiremeijts of a le~al resident of this State.
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; 1 FURTHE CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in
~ . .
! - - -•~~~c~ County,
; Fbrida,~permanently. ~~•''y~ '
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f ' ' • - (Addreu)
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~ -,'fiyyorn t~BSL~st~~scribed before me thi, day of ~
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r
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--'~~.G-'`~ " - ---/-J--- - A.D. 19_~_Y ~
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~ ~~i/'/ II~
i / Notary Public Sta1e of Florida Largc ~
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~ l~ty Gommission expires-----_--__°~`~G" 1~_._ s
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(Tu be eaecuted in duplicate •rnd original filed with Clerk Circuit Courl, and duplicate with Taa Assessor) !
~ aoox 207 ~ACt 2851 ~
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