HomeMy WebLinkAbout2951 d( -
Declaration of C?omicile and Citizenship
"I'U "ftil. STATF Nll ('OUNTY 7'AX ASSt:SSUR,
-.-c~~~ - G_C.e ('OUN~'Y. f~LOk~uA: 243585
Thix is my d«laratiun ot~ D~micilr and Citizrnshi~~ in tiir Stat~ of' Fiorida that l am tiling this day in
acrar~i:~ncr, and in roiiFormity with Sertiun ! 7, Florida Statt~trs.
1 was t'c~rmcrly a l~ka) nsidcnt ot ./YE~' ~1 r_. ./~G~c ~L--- and I
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Ic'it~ ) tState)
rr.i~ird at ~.~i'Ct~SOh Q~~ h~E.--- . However, I have changed my domicile to
(Surrt a~d !~u~nbcrl
and am and have br~n a bona lidr n~i~lcnt ol thc Stat~ of Fiorida since day ot
A '.cST - - . t`) ~f~ . ari~! ! rrsictc at N~st~~Gt _-~a-G.~---- -
. (Slrret and Number)
- p t l. _ _ ~ere ~ . ` . - - - S~___~cs_e_,e1- - County. Florida,
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and this statemrnt is to h~ tak~ n as my drriaration ot' ritizenship, arlual lrgal nsidence and domicile in the State
ut' Florid~.
(Insrr: hrrr ~ny prrunrnt fact~, ~u.h a~ ~Ir uf pruprrty or husin~ss, ~~r rrlinyuishmrnt uf rmploymrnt at formr~
dumir~lr. rrmo~al uf fami!> Io ~~r» dumicil.. punh•rsr of homr. clc.l
l ~+Qrrt h r ND~ ~ ~ ~ 7 ~S
4 ~ ~ar~nh SC~r~~D~C ~~~o/f~rSl~~~~
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. 243585
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t FURTHER CERT(~=Y that I will re;=ister ~t my loral address ~o~hen ihe registration books reopen, and i
~omply with all ocher requir~m~» t~ or a Ir~~a! r~si~ient of~ thi~ State. ~ '
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1 FURTHER CE: IFY that 1 ha~~e nc> int~ntian to r~turn to my forn~~r domici and I intrnd to rcmain in '
~
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_ . --~r~~G~l_'- . County.
Florida, perm~i~~ntly. ~c"•'
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to''and ~Mr~bed brfor~ m~ thi~ 1~. Ja~~ ~~f
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~~ta~.~ r~ni~~ State i.f Il~~tiJa ar~:c
~1y Commission expires l~p - _ ~
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(Tu hr r~rruled m Juplirale anJ ~~rigin:d (it~ d.vith l'terk ('ircuit Court, and Jupl~catr aith Tas Assessor)
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