HomeMy WebLinkAbout0278 Declaration of Domicile and Citizenship
TU THt: STATI: AtiD ('vUnTY TA~ ASSI:SSUR, 241~'4l
~~~Ll~l~_. COUNTY, F=LORIDA:
Tl~i, is my ~lrrlaration ot~ Domi;:ilr and ('itiz~nship in th~ Statc at Florida that l am fling this day in
~cror~i:inr~, and in ~anturmity with Srrtion ~_'?.17, Florida Statutrs.
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1 w:is 1~orn~rrly a lr,~a{ residcnt of~ ~~C~~~--- _ . !'_l~ ~ anc! 1
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r~sidrd at a a--~ - - -~~1 . Howrver. 1 h:~ve changed my domicile to
(S~rrrt and Numbrr)
a~u1 ~m and l~avr br~n a hona tidc resider.t of thr Stat~ oi' [=lorida since _d- day ot
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~ (Stree! and Numberl
- - ~Y<~,~,,~.~d'.~ - - - • _~.-~i~,t~_---~_ County. Florida,
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and this statement is to hr tahen as my d~rl~ration of ~itiren~hip, actua! legal residence and domicile in the State
uf Florida.
(Inser~ hrre any prrtinrnt fxts, ~uch a~ wir uf pruprrtr ut businrss, ~~r rtlinquishment of employmenl al formrr
dumicile. rrmu~al of family to nrav .3onacife, purchasr uf home. rtrJ .
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Mar ID $ 39 aN 'TZ
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I FURTHER CERTtFl" that I will rr,~ister at my loral address when the rcgistration books reopen, and
romply with ~!I athrr rcquirement~ af a Iegal rrsident ot~ this State.
1 FURTHER CE:RTiH Y that 1 tiav~ nc~ i~ttctition to rctt~rn to ttts~ forn~er dotnicile, :~nd l intcnd to rcmain in
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Flori~a. ~crmanentlt~. t~•~~•?
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Sworn t~ and subsrribed hrforr me ttiis ` a_ day oi' .
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otary ubiic Statr ~~f F7urtJa at rgr ~ i _
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:~fy Commission expir~~ ~G ~ . : ;
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(Tu tra r~ecutrd in duplicate and nrivin:d idrd ~~~ih ('lerk Circu~~ Coutti anc~,dJQlicate with Taa Auesux)
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