HomeMy WebLinkAbout4772 Deciarat~on of Domicile and Citizenship
TO THI~ STATt: A ('UUNTY TAX ASSI:SSOR, 244'799
~
' _ - li--~k,. C'OUNTY. E~ LORIUA:
Ti~is is my dr~laration of l)omicilc and ('itir.rn.hip in th~ State of Florida that I am tiling this day in
acrordancr, .ind in c:c~nti~rmity with Section "'.17, Floric±~a Statutts.
1 ~vas tormerly a I~~al residrnt c~l - - - - • and l
/ ~ (c'i~Y ) (scatr)
r~sidcd ~t ~~_l Now~vrr. 1 have changrd my domicilr to
('itrcrt anJ Numbrr)
and am and ha~•e brrn a bona tidr residrnt of th~ Statc of f=larida ~~nce ( I! clay ot
S~ o s, ~
- - - . ~~.:~~~a i <<,~a~ .tc - y~"~'~1
i//'~~-(!` \ ~5treet an~Number)
~ - - - _ ~ . . ,c,c--~~Q County. Florida,
(c~~~ ?
and th;s statemrnt is to b~ tah~n ~s my d~.:laration of ritizcnship, actual icgal residence and domicilr in the State
of Florida.
(Ins~r~ hrrc any prrt~nrnt fact., cuch as vh ut prupen~ nr businru, or rrlinquishmrm of rmployment at formrr
domirilr. rrmo~at uf f~mih U~ nc~r ilu~nirilr. pur.hase uf I~umr, rtc.)
~
~~~OCE
~~O T~A~
~C~.ERi~ CtZCU~t fOU~ W ~
Rf.C0A0 YfRtFtEO~.,+.,..~,.,.
~N ~3 i0 2~ AN'~3
%~•~~'799
I FURTHER CERTIFY' that 1 wiil r~,~ister at ?ny loral ,icldress ~~~hcr~ the regisfration bonks reopen, and
romply with all other requirements r. t~ a Ir,~~! resi~f~ rii ot~ this St:~tr.
1 FURTHER CERT1FY that I ha~•c no int~ntion ta r~turn to my formcr dom~ -'te, and I intcnd to r~main in
_ 1?'~~ ~ C~~ .
- - - '~~~Lv_`, ~!~C~%f.r-' ( ou n t y .
tc-~i. ~ . ~r~~ - - _ _ _ _ _ ,
Florida, pern»iiciitly.
-
~ mey - - -
.S S _~2l ~ z. d n o N ;
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~ ada ss?
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Sworn to ~an~1 s~hsrribrd brt~c~r~ me thi> _ ~a~~ of
~ , : , , . n. u. i ~1 `7 3
r - -
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_ - -C-~ - ~ 5
. ~.rrota~y P~i~u ~~~~r ~~r ~ i~~~,~~ i
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My C,q~n~'s3i~n eh~+itrs~ _ 30 ~ ~'cl 7 800x 2V9 FACE~. 1 U5
t' ~ ;nT,'
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':'rt i "~~(V~r r~rcutrd in JupGcttr .~nd nn~.~n.+l f~l.-E ~+ilh (-Irt~. ('ircuit ('uurL anJ Jupli~atr ~cith Tra Assrs.sor?
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