HomeMy WebLinkAbout1521 Declaration of Domicile and Citiienship
TO THE STATE A1~U COUNTY TAX ASSk:SSOR, ~
, 242621
4-t~~_~~~Gs.Q..___.~_ COUNTY. FLORiI)A:
Tliis is my declaration uf' Uomicile and Citiz~nship in the Stat~ of Fiorida that 1 am filing ihis day in
acconiance, and in conformity with Sccti~n ~~'?.17, Florida Statutcs.
_ ' .
! was fom~erly a lega) r~sidrnt of'?~,t~,c.L°~f and 1
(Ci~y) (Statej
rc~sidcd at 9'__~2~~~,~~lC . However, I have changed my domicile to
(Strrrt and Numbrr)
and am and have txen a bona tidc residcnt of~ the State of Florida since ~ ~f~ day of
,
.
- I--~---- . 19_~~-. ;~rtd ! reside at
` , • Street snd Number)
~ rr~-~ County, Florida,
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and this statement is to be takc n as my declaration of citizenship, actual legat residence and domicile in the State
oti Florida.
(Inser+ Aerr any pertinrnt facls, such as sale of prupert} or businrss, or relinyuishmrnt of empioyment at formrr
damicile, removal uf family to nru• domicifr, purchase of home, rtcJ
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I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
! compiy with al) other requirements of a leg:~l rrsident af this State.
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; 1 FURTHER CERTIFY ihat I have no intention to return to my forn~er domicile, and I intend to remain in
! • .
~ ~ County,
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j Flor~d~: i3~pently. cc ~t. ~ , ~
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. Stv,q t'~'~~nd~subscribed before me this day of
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---~c'_(L~L~Z~1_P~- - . A.D. 19
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Notary Public State of Flo~ • at Lsree ` i~ _
~t~ p~ AAtE Of 16. 197~
` h1y Commission expires--.---------- _ - ~,s: ..~~.c:•~~~~po~r~+\ yE~~cPw~'~~~
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` (To be axrcuted in duplicate rnJ nrifinal fitrd aith Cierk Circuit Court. and Quplicate with Tax Assesso?)
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