HomeMy WebLinkAbout0092 Declaration of Domicile and Citizenship
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TO THI: STATE AND COUNTY TAX ASSESSOR,
_ COUNTY. FLORIDA: `
Ti~is is my ~l~claratian ot~ Uomicil~ and Citi~enship in the State of Florida that 1~m tiling this day in
accoraancr, .ind in coniormity with Section "'~~.17, Florida Statut~s.
I was forn~crly a legal residr+it of ~K-P-~)1!-~~ L,-- .--~d and 1
(CilYl ~ (Slatr)
r~sided at _e'~o ~ _ ' _ ~~Il
~_~1-t~.E'_5-~- . However, 1 have changed my domicite to ,
(Strret anJ Numt+rt) ?
~nd am and have be~n a bona fidr resid~nt of the State of Florida since day of
_ . 19 and 1 rrside at __/_~1~ /'~t2 ~ P /~Vf .
~i^ (Stree! and Number)
I ~ Count Florida
_~L_.J~~ ~ ~ _ • y, ,
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and this statement is to be taken as-my declaration of citizenship, act~ial legal residence and domicile in the State
uf Florida.
(Insrr: here any prrtin.nt facts, such as wlr uf pruperty or busineu, or relinquishmrM oi employmenl at formrr
domicilr, remo~al uf family to new domicile, purchase ot home, rtcJ
-wLe~t.Lc-c- ~u~.eF/L~CC% .c-s<.- /~~t-c~s~-L
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_ 241560 #
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FILEO AND RECORDEO ~
ST.IUCIE GOUNT~ FIA. j
ROCEn ?3+TRAS
CIERK C:~;CUIT COUR'?
RE~QR;~ YE?trl;D~~,
~ ~ ~u ~S at+ ~71
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~ 1 FURTHER CERTIFY that I will registrr at my local address arhen the r~gistration books rcopen, and
~ romply with all othrr requirements of a legal resident ot~ this State. .
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I FURTNF.R CERTIFY that I ha~•e no intention to return to my fornier domicile, and 1 intrnd to remain in ~
~ t~ ~2 h~ - - - ~~~h ~1 - Coiu~ty, ~
~ Flurida, pernianet~tTy: _ • ~
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~ /l . - ~/5~~~'/~ ~Name) t
a - ' : ~ o` ~ - / ~ ~ ~--f` ~ L' c ~
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~ - : ~r ~ ~ - • ( ressl
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~ "5~4~'rp t~t s~b~~ribcd before me this day ot
~ ! . P`~R~,,,
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~ ',~~~~~~~~.~~~~`G`t~i~C~~LI A.D. 19,~i _ .
~
~ - - _ - - - :
ary Public State of Florida at Larce
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- My Commission rxpires I - /y~Z .
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~ (To be exrcutrd in Juplicatr and original filyd ~+ith ('lerk Circuit Court, and duplicate wilh Tax Assessor)
~ BUGK s'~,~E ~7~
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