HomeMy WebLinkAbout2611 Deciaration of Domicile and Citizenship
TO THt: STATl: ANU ('OUNTY TAX ASSl:SSOR. 2,4~05
~J/ ~ ~c•C_~ cr°- ('OUNTY, f~LOR11)A: ~
Tl~is is my drelaration ~~C Domirilr .u~d ('itinnnship in thr State oi' Floricl:~ that 1 am Cling this day in
a~coraan~r, and in cont~ormity with S~ction _'?'.17, Ftorida Statutcs. ~
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1 was ti~rmrrly a Irg.~l residrnt of •s~t~s j?aS~O_~ /~fi~~
/~G.~s and I
/ . (c?ity)~ . (State) :
residrd at 7~_?_ L! !~1?~
~~__CQ~? ~_7~ Howevtr, 1 havc changed my domicile to
(Strrrt and Numt~et) ~
an~l am and hav~ br~ n a bon~ tidr rrsident of thr State oi Florida since day of
~~'~[~~~!.f~_~r l~~z_.__. and 1 r~side at 34/~_- ~er~i-- s~• l 4~.
treet and Numbe~)
~O ~ -S/~ _ v~i~ • L• ~ t.C'i e County, Florida,
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and this statement is to be taken as my declaration ot citizenship, actual legal residence and domicile in the State
ot~ Florida.
(lnser~ hrre any perlinrnl facts, such as salr of pwprrt)• or businrss, or rrlinyuishment of employmrnt at former
domicilr, removai uf family to ne~v damirile, purch•rsr of homr, rtc.)
4 !/e /'1°~/r'P ~ G ~ ~ /ti / e~~s c~ ~,r c3~ 4r~,r~r 7~
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ST. ttJC)f ~3JNTY F[~.
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CtE°K il~;~;~;~T ~pURT
PfCfli?~ Yfi itc~~
~ 8 2 sc PM '11
2434~5
1 FURTHER CERTIFY that I~~ill rctiister at my loral address when the registration books rcopen, and
~omplv with all other rrquirem~nts ol a legal resident of ttiis Staie.
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i ( FURTHER CE IFY t}~at 1 h:~~~~ n~ intention ta return to my fornier domic' e, ancf 1 intend to remain in
,
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; Florida, prrmanrntly. ~`•"y? ycheR.. -/f~--i~e ~y fi~ ~ ~ S
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IName
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, Swcirr~~o~?tQsubsc~ibc~ before me thi~ day ot
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Notaty Public State uf tl~~r at Largc
't ~'~l~ Commission expires _ _o_? - l - _ • ,
(To be r+eecutrJ in 3upiic~tr ~nJ origm:~l f~led ~+i~h Clerk Circuit Cour1. ~nd Juplicate with Taz Assesser)
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