HomeMy WebLinkAbout4995 Declaration of Domicile and Citizenship
244964
"TO TtlE STATF AND ('UUNTY TAX ASSt~SSOR,
.y.Gl~ ~~~-~-~-L ('UUN7'Y. FLOR11)A:
Tt:is i~ n:y t!__•+~c~±l;u!, o! I)omirilr ;~nct C'itiz~nshi~ in th~ Stat~ ot' Florid~ th~t 1 am t7ling this ~ay in
~~cor~lanrr, :u~d in ~ontorn~ity with Sertion '_'_'.17, Florida Stati~t~s.
I was i~ornierly a kgai r~sidrnt of _~CULL~~-~~- . ~~~Cc~~^-- and I
(citp) (stacr)
r~sidrd at ~y.'~~_ ,-G~L:!L- How~ver, i have chang~d my domicite to
(Strret and Numtrc
and am and itavr brrn a bona tide rrsidrnt af the St:+te of Florida since _ day ot'
~
_ _ - . - . 19 ~ 3 and 1 rrsidc at o~ 3 ~
- - ~-t~
-
~ . (Str~rt and Number)
- ~ .•,!'Ui'C~'_ County, Florida,
~
lc~~~~? - -
th~c ~r:~lement it to he taken as my derlaration of citizenship, actual l~gal nsidence and domicite in the Statc
ui ~iviiua. -
(Insrn Aerr any prrtinent fact~. such ati ~:+le of pr~~prtt}' ui businrss, ur rrlinye~ishmant of rmpluymrnt at formrr
domicilr, remo.al ut family to nr~~ Jomic~lr. purchas~ of homr, elcJ
--<~".'~cC ~V
24
/ 4964
STL~UC
E COUMTY fLA.
CLE KCC RCWi CQtIRt
RECCRD VER'FtEp,,,,~~~
Ju~r ~1 3 ~8 PM'73
j 1 f1IRTHER CERTlFY th~~t !~~°il! n~ist~r at my I~ral a~dr~ss ~4~h~n the rc~istration hooks reo~ien, and
! ~o?~~~~ly with all othir requirements of a l~~~ai resid~nt of this St:it~. ~
I~=UR7'HI:R ('ERTIFY tliat 1 ha~~ ne~ ititenti~n to r~turn to my tornier doi icil~. ;~nd I int~nd to remain in
; ~ ~ .
~~-?iL~~G- -t~.
- • - - _ . Courtty-. :
Florici;Y'`[ZfhrWan~ntly. ~c~~~,?
j' J
. • - ~i./~ ~ r
. ~ • . C.'',/If%~ - . _
C' ' ~ ~ : (Namrl
, t.:
' < _ C~ • -
~ r - Rabert R Richner
• , : ~ 1 AdJress) -
. i~.,~' .
~~yo ' '~'d-suhsrrih«1 b~ i~or~ ~n~ thi. ~ ~lcty ~f
_ a~. ~-a~ . .a . E 1 ~
- c~-t-~~2.~ ~oZ ~ ~i-~.~~.~-
- Nutan~ b1i.:-~tste u ,rida at lar:c
~t}• C'~~mmission e~rires ' - ~ ~
(Tu t~r i~ecutrJ in du~•h.:~~r and ~~n~in.A f~lcd »rth ('Irrk f'irruit ('our1. ~nJ Juphcate ~+ith Taa Assets~x)
~~zos~ ~~ss~
~ ~
~ ~r~ ~+w3s
~ ~ ~ ~~,.~,^"~,';.a~^_?xv` € - ~ss° ~.4~~~
_ . . ~ _ ' t-c° "~.P~~