The URL can be used to link to this page

Home My WebLink About4670 ~ Declaration of Domicile and Citiienship ~'•~-~~`11 r~ Ttit~. sT~~ c~c~u~~~Y ~ t~x ass~ ssc~K. `a~~ ~ Gt~ ('UU\"fl'. i~ LOKtI)~: Tliiti iti mt• ~trct:~r:itic~n c~l' !)ottueilc :~?~d ('itiic~~.}~i~, i~~ lh~~ Stat~• ot~ Floritla ihat l am iilin~ Ihis ~lay it~ a~~•~~rtianrr, ancl in runti~nnit~ with Srrliun ,,,.17, l=lorid.i Statutrs. ' ~L .i~ , I w~is formrrl~~ a I~cal rr;i~i~nt ~~f f t~ Ctj. - /ttC: t,cL~~L- and I ; ( rc ~ ~s~:,~r? J r~.i~i«I at ~ tt t~~J ~~~~c. j_ _ . How~~~rr. 1 have chang~cl my domicilt to ~titrcrt ~nJ l~iur»Arr) 1 .in~i am ai~d h;~~~r h~•~ n.~ bc~n:t lieie r~ siclc nt ut~ thr St.~tr of Florida sinre -~~:.:5~ day of ~ '`.~[.c~t ~l 1 ~ _ . 1 anc! 1 r~.id~ a[ ~ 5 . Y! ca, ~ k«i-- ~ ~Strctt and Numtxr) V ~ _ _ ~ l < c _ ~ , - - ~~_c ~ - - Cotmty, Florida, ~c~~. ? :~:6~: siste~ti~i?t is t~, h~• t:lk~~n ,~ti mv ~lrcic~rat~on oi~~itiz~nshii~, artuai i~~al residen~c and domicile in the State ut Florida. t~n,rr~ hrrc an~ prrtin.nt f;~cts, .urh wlr erf ~~~upert> or hu.i~ir~s, ~.r rrlinyuishment uT ~mplu)mrnt at turmrr dum~c~l~, rrmo~~l ~~f tamil)' lo nr~~ dumirilr, purchase ~if homr. rtc.l ,~P~~.~Q~~~M~~ ~ ~rRL11R~4S ; ~~i~~~.~~rF~ ~ ~ ~ ~3 Sa ~f t o'v 7 ~~~~7.~1 ~ ~ ! FURTHER (~ERTIFI" that I~~~ill r~~~is[~r :it m~~ I~~~ai :i~lcir~s, ~vltcn th~ rr~~istration hooks rroi~~n, and ; ~um}~ly ~rith all oth~r rec~uir~im~~t: ut a I~eat rrsi~lrnt of thi~ St~ti. ' 1 f=l?RTHE=.R Ct=kTIf=Y that 1 h:+~~~ nc~ int~titiun to r~turn tc~ m~~ former domi~ilr. c~n~1 1 inttrid [o r<<t~.~itt itz ~ i , ~ ~_t_~ < . • - -~f < ' - - - . (~o} ~ntv- i=lori~3a. F~,•rm,~n~nih. ~t.~~?~a i N ~ ,~ta~u~u?i~r~ , ~.J~~u Z i s4.~ '-L " ' Cg.t'j"l, "L.l~ L- 2 k~ ~ ~ ~<+`t~'~~Q~~i~~ (~iemrl . s, :.`~~~N~~~. V". ~/~!i . _ / 1 , . ~ i j ~ ' -.~ti e i~r~i ~r,~; ) ~ 4 !.~~1~-!L-yl / y% ~ ..:.t ' . - O-f` f. r.. ~ ~ . . 1 ~ 1:\~1:I~e.~1 ; = . _ •~~i to :~?l~t.>u~w~~~ h~•tctir~ rn~~ tlti. <t:~>• ~,f • : ~ , ~ ' i~ ~ ~ ' f ~ - . Q c~ ~ ~ _ " - - ti.~~~~~~ , ~ I ~ ~ ~ - fiL ~ ~.10~ i j~~~ . • ' '+t~`P•~u,uHnN~~~~ ~ i~JC~ a~4 - _ ~ ,h,,. ~~,<<. ..f , , BQax 209 ~~~t-1663 ~ ~t~' ('arntnission ~~~~ir~, Ii~~ ha r~rcutrd ~n ~lu~~li..~t. .uiJ ~~t~ci~:.il fdrd «ilh ~'IrrF. ( rtcwl l'nut~..~nd duph~etr ~~~Ih T~~ A.src~irl) `c~ - .