HomeMy WebLinkAbout4767 Declaration of Domicile and Citizenship
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TO TN~: STATt: ND C'OUNTY TAX ASSl:SSOR. ~4~~94
~,~-~G~~ - ~s.l -CUUNTY, fLORiI)A:
This is my drelarati~m ot' Uami~ilc an~1 Citiren~hip in thr St.itr of Fforida ih~t t am tiling this day in
accoraancr, and in ronfortnity with Sertion I 7. Florida Statutcs.
1 was forn~crly a I~gal resicl~nt c~t~ ~ - • . and 1
. IC~I> ) e~Q `f (State)
r~sidrd at ~p. _ _ _ C~-s~*--e-- _ ~ 'S. _ _ . Ho~vever, [ have changed my domicile to
cs~~rr~ .~~~a x~m~.~
3nd :~m and hav~ brc n a boi~a tidc r~~idcnt of ihe State of Florida since _~.2_ day ot
_ _ . I , L and 1 rn;idr at `~C~t~~~~~ d~ _--~~~-~.Z.. -
~ (St~eet and mbcr) ~
~"'~s~4- . ~ /f/.S~ ~ /?~~e G
- - - _ _ _ - . - - • _ County, Fiorida,
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and this statement is to be tah~~n as my dctlaration of eitizenship, artual legal residence and domicile in the State
of Florida.
(ln~rr~ herr am• prrtinent ixh, surh as wlr uf pruprtty ot bminru, or rrlinyuishment of rmploymrnt at tormer
dom~cile, rrmu~al ui famih• to nr~~ dom~citr. purrhasr of humr, rtcJ
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~~UCIE~COU11T1'
CIERKCC RCUIT~~ ~I ~C,
R~~QR~ ~ERtF1E0
'~w ~ 9 .u ~f '73
2g4~?9~~
I FURTHER CERTIFY th:~t 1~vill rr~~istcr at my ioral address when tt~c mgistration books reopen, and
com~ly with all other requircme~tts of a le~zal resid~nt of~ this Statr.
1 FURTtiER CERTIFY that ! ha~~c no in[rntion to retttrn to my forn~rr domicile, and 1 intcnd to remain in
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` c-~-! Count}~,
i Florida, pertnanrntl~~. .
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'$tyq~6~o ait~su}t}~5ct~ed hcforr m~ thi~ ~ ~lay ~~f
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L.. vtar}• Vublic Statc uf { lurida at ~c
' ~ty Commission ex~ir~s ! ' R 0 ~A 4
~ , 80~~ 2 9~ i~6G
(To hr r~rcWrd ~n dupliiatr ~nd ~m~m.d (~IrJ «ith (lrr~. t'irr~n~ Cnurt. and duplicate wilh Tax Ascesscx)
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