HomeMy WebLinkAbout4768 Deciaration of Domicile and Citizenship
TO THt: STAT = ND ('UUNTY TA\ ASSt:SSOR, ~1~4•79S
p„ , _
,.~i~ _ ('UUNTY, FLORII)A:
Thi~ is my dcrlaration oi~ Uomi~il~ and Citinnship in the Stat~ of [=lorid~ that t an~ iiling this day in
arcordancr, and in conformity with Scction , Ftorid.~ St:ttutrs.
1 was forn~~ riy a ie~al residc ~~t oi~ - - - - - _ , . - _ - - and 1
r~ (CitY) (State)
r~sided ~t _ ~G~C.~__, . Nowcvrr, 1 ha~e ch~nged my domicile to
(Strrrt anJ Numbrr)
and ar.~ and I1:lYt hr~n a bona fide residcnt of the Statr ot~ Fto ' since day oi
. - • I~) an~i I rrsidr at - ' ~
t _
i~ f Jr~Se~~ (Strra~ and Number)
- -~--.~~~l~- , - ~-r~~=--- C'ounty. Florida,
~c~~> ?
and this statement is to be takrn as my derl~ration of citizenship, actual Iegal residence and domicile in the State
ot Florida.
(InseN hrre an~ prrlinrnt farts. ~uch as wlc o( pruprtip or businru, or rclinyuishment ut rmpluyment at former
domicile, rrmo~al uf family to nr~~ domicilr, purch:ur uf Aumr, rtc.?
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FiLEO ANQ RECORDt'0
iT.IUC~E COUMTY FU.
~ lIOCER POtTRAS
CIfRK CIRCUIT COURt
RFCORD VERIFIED
,1~ 3 9 3c AN'~3
;~~4'795
~
; 1 FURTN~:R CERTIFti' that I will r~_~ist~r at my lorai aJdress ~~~hen Nu re~istr~tion books reon~ri, and
' comply with al( othcr r~quirrments ot~ a I~,~ai r«idrnt of this Stat~.
I FURTHI:R CE:RTIFY that ! hati~ ~jc~ i?~trntion to r~turn to my fonner omicilr, c~nd 1 int~nd to remain in
~~1--~ ~ T /~~!a't%L'V - _ . C~UIUII
f - - - • ) •
Florida, p,•rmanently. ~
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i : S3~vSA o and s~b~rrit~d befc~rc mr tl~i~ ~ ~i,i~ c~t
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~ary Vublic Statr ~~f tl~rnda at e
~t~~ Commission cz~~irrs ~ - ~ 800K ~Ve~ VAGf ~ ~U~,
( T~~ hr r~r~ulad ui dupl~catr :~nJ ~~n~~n.~l fdrd ~~ith l'IrrA ('~rcuA ('uurL :+nJ dupliiate ~crth Tax Aacessor?
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