HomeMy WebLinkAbout4516 Declaration of Domicile and Citizenship
"rU TH!_ S7~ATE NI) COUNTti' T'AX ASSt~:SSOR. ~ ~44f,2s
~ ' ^
~-~L~ C~'c.~,P_ _ COUNTY, FLORIUA:
Tl~is iti my drrlaratiui~ of Uomirilr an~i Citirenship in the St.itr ot' Flurida that l am tiling this day in
accor~iancr, and in ronf~rmity with Sertion 11~.17, Florida Statuirs.
1 was forn~erly a Ir~al rrsidcnt ot~~~__~%l~! ' and 1
, (Cit>•) - ~ • ~
(Slate)
r~sidcd at . ~ ~ ~ _ _ _ ~ . How~ver, 1 havc changcd my domicilc to
(Strert an Numt+rr)
and am and havc b~rn a bona tide r~sident of the State of~ Flori since ~s~~___~ day of
, 1
~.C -7~ • - - . 19 ~ , anc! 1 residr at --~'`'cti ~ ~n-~
~ (St and Numbrr)
_ - - f _ ~ _ - - ..~~~-~'-'--e'~~~~~~=~-~ _ County, Florida, .
luty
and this statemrnt is to hc taken as my derlaration of ritizenship, actual legal residen~e and domicile in the State
of Florida.
(lu~rr~ t~rrr an~- pertin.nt tacts, sueA :u sslr of prupetty or bucinrcc, or relinquishmrnt of employmrnt at former
domicite, remm~at of faniify tn nrw domi~•i)e, purchase of home, etcJ
~j'yI~`'~
~
~
~
' 1 f=URTHFR CERTIF=Y th~it I will re~ister .it my loral :~ddress whe?~ ih~ re~~istration books reope>>, and
~ com~~ly ~vith all other reqeiircments ot a lr~~al resident ot~ this Stat~. ~
i
~ 1 FURTHE: ~RTIFY that I ha~~c ne~ intention to r~turn to my forn~rr domicile, and 1 intend to remain in
` t- - - -
, " ~ - _ - - . - - _ . County.
t=lorida, prrmanrntly. ~c~"•~
` .,..~u~~,, • ~ . ~ i 7 C l _ i f.
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~ : . t.fC 1~i~ (!`amr)
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_ ; C,Q < . _ I:~dJrcss) ~~~L1
' ~ V~3
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Sr~coS~~to and~ t~bed hetorc me this ve ~ cfa~• of -
• ~ -
E'' i~ ~ ' fj lEa ANO RFCO~ 1
: a',;• l,~ L4 r t~' =T. WCIE COUNTY fL4
A. U. 3 1_ R O CF h POiTNAS
~ ~ ( n~~!1 ~ CIERIf Clni.illT COUqT y~j/~ l/l~
; RECORC vEFt~iEfl~.....,L~L:~
- . utary Puhlir Statr uf 1 Inreda ..r~~ ~ 1~ 2 os PM'~~
~1y- Commission e~pires ~
(Ti~ hr r~rcutrS in dup6ca~e ,~nd nneinal f~IrJ ~~~th ("Irr~. ('irwit ('nurt, anJ Juplkatr aith Tax Asseaor)
, at'Cr ~AC' 1~~9
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