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Home My WebLink About4798 l~.r•s zv~.rv Deciaration of Domicite and Citizenship "I'U THI: STATL A~'U ('OUNTY TAX ASSt:SSOR, ~ . . t'OI.~NTY. fLORIUA: Tl~is is my drrlaration uf Domicil~ :ind Citizrnship in the St:it~ of Florida that 1 atn tilin~ this day in accoraanrr. .?na in ronti~rmit~' with Sectiun ~'_'.17. Florida Statutrs. I was fonnrrly Ir~zal resid~nt ot~ ~__l,z~_%v_~. V_1_1-! e- •-~_~z'.~1t711_'2-_ and 1 (c~~y? (s~ace~ r~sided :~t _ y . a _ -r-t-~-Q--~'~. _ . Howrver. ! have changed my domicile to I~!...~~ an.1 Numberl \ and am and havr txcn a bon~ fidr rcsidrnt ot~ the State of Florida since ____L,~~ day of ~.!.~~~_L~ _ _ _ . 19 ~ ~ and I r~sidr at -3- t~) , _ N v S ~ p~-.~~ ~~'~C'.~ (Strert and Number) o~~ tl•t'C 1 • ----~~~~~i_-~_~-t~ County.Florida, ~c•~~. ~ and [his statem~nt is to b~ take~l as my declaration of citizcnship, actual k~gal residence and domicile in the State of Florida. (Insrr. hrrc any prrtinrnl f~clx, such as c:~lr of prupertZ or bucin~ss, or relinyuishment of rmployment at formrr domicilr, rrmo~:~l of famih to ne~v domicilr, purch:+sr ofhomr, rtcJ , Yy ~ ~ ~~E~12-~-L, -L-cx.-,n/ ~~7~. 1Er~~~-~~ ; ~ ~ ~ ~ .a,-c~-e~ ~ ^ ~~~co c°'~ ~ !'~=s-L~G~~ ~to~F~ aar~~x. - ~~~t+c ~~~c~~ ' +r~ex~n ~a~F~ee~~~ ~ 3 !1 ~ ~y'73 . 1 FURTHt=R C:ERTIFI' that I will re,~istrr .it my Io~al addnss when the registration books reopen, and com~~ly ~vith all othrr rcquircm~nts c~i a(~~.ii rrside~zt ~i thi. Stat~. 1 FURTHI;R Cf:RTlFY tl~at 1 1~a~~ ~:o intention to return to m~• iorm~r domicile. ;~nd 1 intrnd to rem~in in ~°ie~ 5~--- ~1., ~C / ~ cJf " -1~-_~_~'_1_!~ Co~mtv, - Flurida. perman~ ntly. ~r~~• ? " ' i ,..,...,:~~u~~. s-<.-Q - `-d~~~-C - - - • i. !}r ~~~~i~ (Namr) , - . ~i/ L ' J - ~ 3 7 S~. C.~.J. L_ 5..~~/~ i F~/L/l~Cl C~~ ~ ` ~ . ~ , r , • ~ ~~aa~«~? _ _ _ _ : r~ ~ • = ~j ~ ~ $woru~o at1fG;~t~a"be~l h~fc~r. m~ thi~ J ~a}• of ~ ~ -~~~C~C o • - , . : - ~ ~ _ . .4 1 / . , - ut3ry Alic Slate e~f ! I~u~Ja at Lnr~e _ ~6 - 7~ ~~or209 ~{~.:2 t91 ~ty t'ommission ~ ~nirrs . ~To hr r~rcutrd in du~~l~ca~r .iod nn~in:~l f~1rJ ~~ith l'Irrk ('ircuit Ci,url. ~nd dupl~crte •xuh Ta~ ASSCSMNI 'P'-~ _ - ~ `~`~''~.:~-Y x..a.- e° s . - _ . . . _ . _ ...~.4 ~aa.