HomeMy WebLinkAbout2474 Declaration of -Domicile and Citizenship
CO THk~ STATE AND ('OUNTY TAX ASSl:SSOR. , 243308
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- _ C'OUNTY, t~LOR1UA:
Thi. is my drrlaraiion af Uomirilc ~ind Citi-r.rnship in ihe Statc of Florida that 1 am filing this day in
ac;runlai~c~, and in r~~nCorntity with Srction ,~".17, Florida S[atutrs.
1 wati t~orn~rrly a I~~;al rrsid~nt of _N~A ~~'V ~ N'~ .~nd t
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IC'itY 1 (Statr)
r~si~lyd at ~~~G'~ _ CL~y~!eST --~J_v~~ _ _ _ _ _ _ . Howev~r. I h:~ve changed my domicite to
~Strerl and Numbrr)
ai~d am 3nd have brrn a bona iidr r~sidrnt oi the St.itr of Florida since~~~~_ ~ day o1~
. I ~ and I r~sidr at " `y` ~ ~ /
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(Street and Number)
lo,er ~T_ LvC/L~----- •-----~r~_!/ C~± County. Florida,
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(City )
;uid this statemrnt i~ to be tak~n as my de~laration ot~ citizenship, actual legal residence and domicile in the State
ui~ Florida.
(Inuri hrrr any prrtinrnt facts, such rs salr uf pruprtty or butiinrss, ur relinyuishmen! of employmrnl at formar
domirile, rrmoval uf family to nr~~ dumicde, purrhase of home, rtc_)
,~u„~iaa~ 4~ ~ arn.t ~c.w ~/an-~-~~ .
FILEO ~K~ RECOROEO
ST_ LU~IE COUNtY FIA.
ROGEk ?OITRAS
CIERK Ci'r,~U1T C~JURT v
RECO~^ YEP!~lED
OEC 1 12 os PM'72
2433U8
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~ 1 FURTHER CERTIFY thai 1 will rrgister at my local address when the registration books reopen, and
rom{~ly with all other requirements of a le,~al resident of this State.
~ 1 FURTHER CERT[FY that 1 ha~•~ no intention to return to my forn~er domicile, and t intend to remain in
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/O,~T~T l/~'/~" y, '
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~ ICit. 1 ,
~ Florida:•~n~ni;~n~ntly. ~ fc ~{.1t A?"~ ~ 12
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~ ~~vc~i4r~o"..~,~t~bscribrd beforr me this _ day of
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~ e C'---- _.;~.D. 19 _
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Nutary Publ • tate uf ilonJa at LarKr
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~ ~1y Commission expires---.--~ .l-~-~
(T~ t~ rtrcuted in duphcatr and unKinal filyd ~cith Clerk Circuil Court, and duplicate with Tax Assessot) ~
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