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HomeMy WebLinkAbout1583 Declaration of Domicile and Citizenship ~426'70 TU TNt: S'TATI: A\D ('UUNTY TAX ASSI:SSOIt. ~~~~-srt~-~ ('Ol1N"fY. FLC)Rli)A: Ti~i. is my dr~l:ir,itiun cst Domicik .~nc1 (itiz~n~hi~~ in tl~r Statr of Hl~rida that 1 am l7ling this day in accar~lanrr, aml ii~ «~nl'c~rmity witl~ Srrti~~n ",.17. Floridu Statut~s. ( ~vas t'urm~rly ir~al rrsi~lrnt ot~ _ . and ( ~ rr~i~ ? 1sc~ce~ rr~i~i~d at 9~~Q _ . Eluwrv~r. I havc chai~gcd my domicile to trrrt ~nJ NumAer) and am and ha~~e brrn a bona tidc rrsictrnt of titc Siat< ot' Florida sincc /.o~` day ot~ _ . ~0-2~~~'~ . 1~~.2?_ . anci i r~;~dr at l~ --.H'~-t.~.~~_~~ = / (Slrrrt and Num ) ~ t/,~eth~V.u'l~ c~..~ _ . ~~-~s~i - County. Florida, t~•~~• ? :+nd this statem<nt is tu br takrn ~s m}< <ir~laration of ~itizcnship, artua( tegal residence ~nd domicile in the State ut Flori~ia. (In.at~ hrrr any prru~rnt facts, cuch ;~s s:ik c.f pruprrty ur trwir~rss, er rrlinyuishment of rmpluymrnt af former dumi:ilr. rrmu~~l uf famil~ M nr~v Jumi.~lr, purcha~t of homc, rrc.1 2426'70 .~~~C~a~.Ct~y /~GQ,e-,~.e -e~~ f~tE~ ar~ ~!fce,~Df~ ST. tUCiE CCUMT!? FLA. ROC F P~ITRAS CtERK ~CUIt CBURT REC.^•R~ YF~~'r1E9..~~ Ner 2l 2 ii PH'~1 , ~ ! FURTHr.R (~ERTIFl` that 1 a~ill rc~•i1t~r at my loral ;tddr~ss whrn thr r~~,istration hooks reopen, and I comply with all other ~equiremrntti of a l~gal r~si~icnt ot this Statr. 4 ~ 1 FURTHI:R ('E:RTIt=Y that 1 ha~~~ n~ intcntion to r~turn t~ my form~r domicile, and t intcn~ to r~main in i ~ . ! • ~ _ _~:~r t~ _ - - _ . . ~~-_G-4--G-! - _ - - . (~oltllt)', ' 1(it~) ; Florida, permanrntl~~. • 17/f~~ r. ' ~ ' . , . , - o~ ~ J • , . . . . ' ` : • r . •~•1/~ . , . . . • • . . _ . _ ~ . `y ' t V i , ~:'t ~ , rl ' . ~ ~ ~ ~7~~ ' _ . ~ . • ~ - ~ ~ ~ ' 71? ? ' . _ ( ~ , , ~Z ` ~4~ ,v'. .8worn to,and si~Nscribed h~f~~rr mc tlu. c1c~~' of f ''Y~ .~t - ~ _ _ . n. 1 .?r . ~•~r~~ ~-t_ . - ~~taty Public Statr uf Ilur~dr :+t 1 ar_e ~ ` ~1y Commission rr~ires _.__`t'`'`'~ _ ~`J ~ ~ ITu br r~ecutrd in ~fupl~catr a~~d uni~n.+l f~IrJ wilh ('lrrk ('ircuil C'uurt. and duplicatc ~+ith Tax As.crs.wr) ~ . ~ ~ ~~~K 2~IS ~~~E i583 ~,.-t ~ • - - - ~ ~ ~a.,-~" ~r~ ~ ~ ~ ~ - - -,r - . . ~ ~