HomeMy WebLinkAbout2094 Declaration of Domicile and Citizenship
"t0 TNE STAT ' ANll COUNTY TAX ASSESSOR, 243040
COUNTY, FLORIDA:
Ti~is is my dcclaralion ot' Uomicitc und Citizcnship in the Statc of Florida that ! am filing this day in
acrotdance, and in conforniity with Section ~?'_.17, Florida Statutes.
~ ~ . .
I was formerly a tegal resident of _ _ _ and 1
. lcitr) (state) -
resided at . Nowever, 1 h:~ve changed my domicile to
(Strret and umbrr)
and am and have be4n a bon~ fidc rrsident of the State of Florida since day of
~ ~
, 19--~~, and ( rcsidr at L
1`y/' / ' , (Strcet and Number)
~d.,_
~~1 . -,~~c~i~l~6~~~ County, Florida,
(cityl
and this siatement is to be taken as my declaration oti citizenship, actuai legal residence and domicile in the State
of Florida.
(Inxri here any pertinent facts, such as sale oi property or business, or relinquishment of employment at formet
domi~ile, removal of familY to new Aomiciie, purchase of Aome, etc.)
Citi' . ~
i~G~'',~~ J~~~ta~'~
(J
~
LUCtE ,~'^.ou~,r°~
ROCEk POtTR*g SI~ ~
CLERK CikCUIT ~p~
RECOFtO YERtf1Ep
~6C ~ ~ ZT ~
.
243040
I FURTHER CERTIFY that 1 will register at my tocal address when the registration books reopen, and
I, comply with all other requirements of a legal resident of this State.
' I FURTHER CERTlFY t• t! ave no intention to return to my former domicile, and 1 intend to remain in
~ . -
,[1~.~ o - - ~L~L- - , CountY,
Florida~_permanently. t~'"'~ . ,~~,...~,,'e ~y,~ zi
~~\\it~~11~1If1f~ '
/~l~
: ' ~ • ~~L 1,r% '
` i':~~~N~~~~~~ ~ • - »
~ ~ (Name
. ~
~i
pT~i
~ : ~ = S~ ~~~u~~~ -
; (Addrcss)
' ~ ~ U: . ,t,~6 :Lv i
. y,~vstoc~;~~n~~~~bed before me this day of
l~~ 'A' ~ ~ .
7• ~~~~~M•
• A. D. 19
- '
. !~~'L_--~~ s
Notary PuAlic State of F~lorid Lar¢e ?
; ~ r~ar~nc romx n~t~ o~ n~
My Commission expires-----_ ~tY ~~~~~vN ~~H~ FEBr la„ 197~
:W~Y-3M1W ~i~ M. D:~t3RJiQg~
, (To t~e exrcutrd in duplirate anJ origin~l filed with Cle~k Circuit Court, and duplicate with Tax Assessorj
SOQK ~OS PAGE~9~ . , , _ . .
~Y ~~~~y ~ - ..r_ . . .
a'~ a.~"' .X ~ ; j ~ r, . ,
~ ~ ~~~yc ,h' t . • ~ a~~'T«~' .
~
~ € ~ a
s;~, ~ b ` } ~
a~; . _ ~ _
' . ;;u~