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HomeMy WebLinkAbout2619 Deciaration of Qomicile and Citizenship "~O THt~ STA AND C'OUtiTY TA\ ASSt SSOR. 2434~.0 Jy~~~~ - _ C'OUN"1'Y. I~ LORIt)A: Ti~i. is my cl~claration oi' Dotnicile and Citirrnship in thr Stat~~ oi' Florida that t~m filing this day in :ircorclanrr. :utd in cont~c~rmity with S~clion ,,,.17, E=lorida Statutrs. 1 was formcrly ir~at r~si~l~nt ot~ ~ - _ - - _ . ~1_--~_ , _ and 1 t ~ ls~~~r? rrsidrd :~t _ ~ ~ - - _ _ . _ _ How~cvrr. I have changed my domicilr to (Strrrt anJ Nu~obrr) and am and ha~•~ br~ n a bana t i~ic r~.i~h nt ut~ thr State oi~ Hlorida tiince day ot ~'c~ _ ~ _ _ _ . i 7 ~ ~ r„~a~ .~t -3 ~O_---- .So_- --3 S f • _ ~ (Strrr~ and Numbrt) - ..~~Z~~-~_ . _ _ - • ---.y-1~+5G?_~--~~-~------ COllllty. F~Of1C~.l, (l'ity 1 a~xi this staicmr~tt is to bc tak~n as my (I~CIJfilIl011 Of Clh"Lt'i1SI11[~, :1CtU:lI ICg,I il'Sl(~l'i1Ce 311(I (IO(111CI~t'. 1? ttlt S[,t~ ot~ Flarida. (Insrr~ hrr~ ~n>' prrtinrnt fartc, ~uch a. vk uf pruprrty nt bosinris. ur rrli~~yuishment uf rmployment at former damicilr. trmo~al of famih• to nc~c dumicili. purchasr of Hom.. rtc.) ' _ I ~ ~i~.l~~`/ ~ ~ ftLE~ Ab~ ~~Ci?ROE~ V' ~ ST_toc:~_G~v1lPr f~~- ROGc:~ r,lTF2AS CIERK ~'~::•iliT COORT aE~OAt~ ~~z-~E4~ pE,c 8 3 4o PM'7t - 243410 ; _ ; 1~URTHER CERTIFY that I~vill nri~tcr at my locai ~ddmss wl~en thc rcgistr~tion books rcopcn, ~ni! comply with all oth~r requirement; ot~ a le,•al r~si~irnt oi tlsis Statc. ` 1 FURTHER FRTIFti' tit~t 1]~~?~~~ n~> intentic~n to r~turn to mv forn~er domicile, and i intrnd to remain i~~ ~ ~ ~ ~!~G ~F . ~.~t Gz--Q -~c.--~ "~s:~-~ " - - . Co~mi ~ . Florid:~: ~ie'riy~~rrr;~~tl~~. tr"•, • - _ C , ~~~..~«~ti ~ii , / , ~~~;9!ss~ , ~ R~~G~, . • r~ R~. . - - - - _ - - = r~~.i i . S ~ (~ieme) ~ • ~ . ~ , . ~ . : p ~ ' : /~Gll~~f /Chc eN~~r/~ s v~g . , . - - - _ E. ` ~ . - _ _ _ _ ia~aar~s~~ ; r. ~ ~ . 3 ~ ' 1 - ~ Swor~S~L6L:p~3i1~~iEf~cd hefor~ m~ this ~ ~lay~ of y - ~ ~ ~ --~C_; - _ _ . A. 1 ,7 _ ` . i ' _ ~!!E!~'! J%~ - - i otaty Puhlic Statr ut fl~xida at Fr ' ~ ~ :11y t'ommission cxpires_~_- !W - (To he r~rcutrd in dupG.a~r anJ un~:~n:d filrJ ~~ith t'ler~~ ('ircuit Court, and JuplKalr ~~ilh Tax Assessor) a~z08 ~6i8 _ ~ - . ~ _ - ~ v ~