HomeMy WebLinkAbout4963 r
Deciaration of Domicile and Citizenship
;~44943
"t0 THt: STATt: AhD t'OUNTY TAX ASSL:SSOR.
.
. COUNTY. FLORIDA:
11~is is nty drelaral~on ot Uom~cil~• :~na l ititei~sh~p in the ~tate ot Fioricia ti~at 1 atn iiiing ihis ~iay in
accor~l:~ncc, and in conformity with Section ?_'?.17, Flurid~ Statutrs. ~
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! w~s t~~rmcrly lr~~:~! reside~~t oi~ _"/i1 ~ - - - and I
(Citr ) (statrl .
lf`
msidcd at ~_6 y------_---~ . However, 1 have changed my domicile to
(Strret and Numt+rr)
snd am and have b«n a bona iide residrnt ot~ the State oi~ Florida since day of
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_ _ _ 1 and 1 r~sidr at -~L__-
- - -
(Strret and Number)
-dl.~'-~.,2 - • . ~ County. Florida,
(cti~>~ )
and this statement is to be taken as my derlaration ot~ citizenship, actual legal residence and domicile in the State
of Florida.
(Insrn herr anc prttinrnt facts, such as salr uf proprrly ur businrss, ur reli~iyuishment of employmenl at former
domicilr, rrmoval uf family to nr~v dumuilr, purchasr of homr, rtr_)
t~e~~ ` ~ a~.~ ~?I a~.uc~2- - .,c~``~'c.~e~"
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fR,E@ ltN3 RECQROEI
ST. UICIE COtpITY FLA.
ROCE~ POITRAS
CLERR C1RL'~IIT COtIRT E
R~c~an ~~:F~v:~a
~ .MN ~i i PH'73
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~ I FURTHER CERTIFY that 1~vill r~~_istrr at my local address when ti~~ r~gistration books rcoprn, and
~ romply with all othc r requiremrnts of a le~~al residcnt af this State.
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~ FURTHER Cf:RT(FY that I h;~~-~ no intention tc~ return to mt~ t~orn~rr domi::il~. and 1 intend to remain in
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~ ~ ~ ' ..t~t~CQ . . - ..c.~-c'-~`-'S~ - - • C~ount}•.
- - - - - - -
~ Florid~, permanrntly. ~e"'~ ~~Lf1/i ~ e c d
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3= ~yt~t~e~'bq :~nd subsr~ibea befe~n tn~ thi. ~lay of
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ary Pu c Statr I lunda at Lar~r o~~
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~1y Commission ex{~ires _ l~ ~ 3 - -
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~ ITu br r~rcutcd m duphcatr .:nJ ~~nF~n.~l filyd ~~ith ('krk ('~rcuit C'uurt. and duph~atr ~~ith Tax Assessor)
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