HomeMy WebLinkAbout4766 Deciaration of Domiciie and ~itizenship
TU THE STATk: ANU COU~tTl' TAX ASSt~SSOR,
N
- - CUUNTY. f~LORIDA: '~'~4~ ~9~
This is my ctrclaratiuis oi' Domirilc and C`itizcnship in thc Statc ot~ Florida th:~t l am filing this day in
acrordancr, and in conformity with Sc~tion ?~_'.17, Florid:~ Statutes.
I was fornietly u ir~:al residcnt of -;~e~! ~~1~-~ g and 1
- - - - •
/ (~.~~Yl - (sate)
r~si~ie~ at ~~-6_ C_ ~;1~~--~~------ . Howrver. I have changed my domicile to ~
(Strert a~J Numher)
;~nd am and havr txen a bona fide resident of the St;~te of- Florida since day of
. 19. 7~_. and I rrsidc at 5=2~~~~~~~--- - ~
p,~ . ~(Str t and Numb~r)
~~yl - - - - . _ County, Florida,
- - - (c~>>•>
and this statemcnt is to b~ iake~~ as my dcclaration of citizenship, actual legal residence and domicile in the State
of Florida.
(lnsrr~ here any prrtinrot facts, such as salr of pruperty or businrss, or reli~yuishment of rmptoyment a! formrr
dumicJe, rcmo.al of tamih• to nr.. domicilr, purchasr of homr, rtc.)
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f~LED 4MQ RfCOR0E0
fT. WCIE COuMri f1~
CLfRK
C RCUIT C~OtIRt
~ ~ ~ RECORO YEZIFIED.,,.,~~
.~N 3 9 Os AN'73
,
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' 1 FURTHF.R ('ERTIFY that (~vill r~gister at my local address wh~n the registration boo{:s reopen, and
~ comply with all other requirem~nts of a Ie~~:II f~St(~lilt Ot tIIIS SIJtC.
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~ I EURT'NER CE: 'Y ih~+t 1 ha~~e nc~ inteiition to rcturn to my fonner do icile, and 1 intend to rcmain in
:
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Nutary F c. tat t f l~,riJa at ~ar~r
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° ~1y Commission c~ires _ 6QOK ~O~ PA~t 1 ~Jc,~
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( iu hr c~rrulrJ m dupli..~te ~nJ ~~ncm.~l f~lyd .~uh l'lerk l'ircuA Cuurl. and dupG.atr with Ta~ Ascessor)
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