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Home My WebLink About4740 vl , Declaration of Domicile and Citizenship TU THt: S7~f TE AI~U ('vUN7'Y "TAX ASSt SSOR. ~ ('OUh"i'Y, {~LURiI)A: This i; my ~hclaratiun ot Uomirilr ~n~t ('itir~n~hip in thr Stat~ oi Florida that I am tiling this ~lay in arcor~l:~nrr. an~l ~n contornut5~ ~vith J~rtion i 7, riori~i.~ ~t:uu~rs. 1~va, t~omierly a I~ ~:~I re sia~ nt ~~t~ ~e - C~ ~t C!~ lj ,~~/~LI C~< ~i~ t, t~. and 1 ~c ~cin~~ - - (s~a~r) r~sid~d .~t ?~L~ li -(!t.°~~'~~~~~``- . Now~v~r. 1 have changed my domicite to (Strrrt and humhrr) :~nd am and hav~ hrrn a bona lide msi~lrnt of th~ State ut~ t~lorida since 3 U~ d~?y of ~7 ~~C E /22 ~ r . 1~~ 7.~_ . :~n~i I ntiid~~ at ? 1 ~--~/~?E' ~ /~P~/--~~ ~ S~` -f - (Strcet and Numbrr) l~~~r~ _-~1-._ , ~t~.iL C/~'_- Caunty. Florida, ~c~~> ? and this statemrnt is to h~ takr~~ ~s my declaraUon ot~ citizenship, actual legal residence and domicile in the State ~,1' ~I~ri~l;~. (Insrr. Aerr ~n> prrlinrnt f~c~s, ,uch as salr of pnrprrly or husinrtc, ur rrlinyuichmrnt of rmplo>mrnt at formrr domi:ilr, remu~al ~~f famil>• tu nr~v dumic~lr, purchase uf homr, rtr.1 c2 l'P. LI f~~~'~ ~~,tC~ ~/1)~ • ~ 's~ lUC E COUNTr f AOCEA pp~T~s ~ CIERK CtRCUIt COURT RECORO VERsF~EO.,~ ' 1 3 , ~ ~ ~ PM T3 I f i i ~ ~ ~ ~ ~ : ~ ~ ~ ~ 1 FURTHf:R ('ERTIFl' that 1~~~ill r~~~i.tcr at m}' lo~al a~ldrrs~ ~ah~n th:~ r~,_i~tration hooks reo~,en. :ind ~om{~ly with al) attirr r~quir~m~nts ui a l<<~:+1 r~~~i~i~nt c>f thi~ S[:~t~. I FIIRTHF:R 'ERTtFY tiiat l hci~~ nc~ intcntir,n to r~turn t~> my formcr dornicilc. and I intend to rrmain in ~ ('uunt~~. ~ ---Cl--Sr ~ ~~L'f~G~'-c..< ~ • . Fl~~rida. p.•rma~i~ntl~. ~c ? ~09 cR S ~ ~ ~ )C ~ 'L~l~t-.~ " 1'~~ ~\amr) ~ J ~ ~ _ ~k ~ ~ . '~W.^r,.i . . . - , _ . . "~lt~ 1 ~\~ljfl\s) ' , •.1 ~ ~.I~i 1 ~~i V''~~N~~~~~. y ? SyTQ~Tl;.tb 1nd ~t~~i~l~f~'~J b~ti~r~ nt~~ Itti. c1:?)' c~1 ? j-~; ~ r_ ~ ~ .r . ~ . ~ e;-: c==c. ~ i. . ~I : = . . :1.~~. 1~~~ ' ~'.'i ~ "1~- ~ . ~ L~ ~ f - ' u ~ ' ' r ~ ~"1 ~R - ~ t•. . ~Q. s~.~ - N~7Whhi r i.f 1 1 n~.~ .~1 l.+rcr r ',T O; ~ ~1y ('on`fmir.tiiorr~`~{~ir~s ~ ~ /G ~ ~ 17~~ hc r~riu[a•J in .iu~•in ~tr .~nJ •~nan.+l id.•J ~~rth l'Irt1. (lr~~nt (~~urt.:~nJ Jupluate ~sith Ta~ Assresurl ~ ~~~,K~Q~ p-,~~173 u R ~ 3 . - ~ ~ _ = ~ - . . ~ _ .