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Home My WebLink About2385 Declaration of Domicile and Citizenship 243244 7'U TNt: STATF ANU ('UUNTY `l'AX ASSt:SSOR, _ _ CUUNTI', F'Lt)RIUA: Tl~is is my ~Irrlaratiun ol~ Uamicilc :in~1 Citi-r.~nship in thr State of Florida that I anti tilin~: lhis ~1ay ii? acrordanr~, :ind in cont~ormity ~vith S~crtion ~_'_'.17, Florida Statutrs. 1 was furn~erly a Icgat rrsi~t~nt of L.1~'~-~-~ , and I . - - - - - - - - - - _ . - p' ' . ~ . ~s~a~r? r~sidrd .~t 1'_D Q-~;~~-~-~~~ Nowrv~r. 1 have changed my domi~ile t~ (Strrrt and Numbrr) and ,am and have brrn a bona tidc resi~irnt ot thr St.ite of Flo~i a since •iy oi Gc'-/l t- ~G~ ~ Y- / . ? . _ . 1 ~J _ _ . :ind 1 resid~ at _ . ~~c~ a-s~G~ _ ~-~Jy /~-~~2~~' - ~ (S " e~ Number) ~,~-4~_ 1 ,/1 ~ - ~ - - - - - - • - a~~~? - - County. Flori • . (c;~.> - - and this statcmrnt is to bc take~~ a. my declaration ot' citizc nship, actual ltgal resid~~nce and domicile in thr Statr oi' Florida. (Inser? hrte any prrtin.•nt facts, .uch as wlr of pruprrty or bwinrss, ur relinyuishment of rmployment at furmrt Jomicile, rrmo~al ut f3mily to nr~v Jumicilr, purchrcr of humr, rtc.1 I . ~ ` - e!~ ~'"J~ ~/!C-L.~ G~~~-L/ i~ ,~jt ~ _ / 24324~ ST.l,UC E C~JMTY f~A. ROC~F =~ITRAS CLERK ~,~.~,u1T COURT RECORp V~fi~F~~p ~ DEC 6 1~2 PH ' T~1 ~ I i ~ I l URTHER CERTIFY..that I~~~ill rcgistcr at m~~ lo~.il addr~ss when thr registration books re•o~;n, Jn~t ~ romply with all other requiremrnts of a Ic~~ai r~~ident ot'thi; Statr. ~ : E 1 FURTHER CERTIF1' that 1 ha~~ r~c~ intr~~tiu~~ to return to my lbrmer domicile, and~l intend to r~main in , : ~ - ~ , = ~.C'.~2C~ _ _ _ . _ .~-4-~/• .-~-t_t~L (~ountv- _ . - - Florid_~ ~ermanently. n - 01`' i ~ ~ ~ `..•h _ - (Namr) - - - - . c ~ - Nenr S . Dekker • • • - G ; . . ' • u ; : ~ L~ . - - - ; _ ~1 ~ : ~ = - - _ _ _ _ I AdJress) v ~ . . ~ . . ` ` . St~Orn•to• '~~'~tZ~bscribcd brfor~ mc this ~ ~ia~- ~~f~ i;~R ' ' i ~ ~ ~ ~ f - --L_C-f_ L_ G~-~., _ . it.I). ~ 2_!-. _ ~ _ _ ~ s - ~i_-t~t~t.-~j L C~t,~~~~ : ; - S'tarry Noblic Statr nf F IuriQa a~ 1 rt:.• - ~~y con,~n~ss~on ~~~~.~5 ` c~~ . / / ~,T~ s ' (To Fre r~rcuted in duplii.~ti anJ nriL~n.d f~lyd .wth ('lerk t'ircuit Cuurt. anJ Juplkatr MitA Tax Assrssnr? t ~ , O~~M F'A~i,2,,S~~` ~ ~ : ~ u~ * . ~ gr :~x - ~ " = ~ _ ~ : ~ x=` _ .