HomeMy WebLinkAbout4996 Deciaration of Domicile and Citizenship
"TO THl: STATI~ AND ('OUNTY TAX ASSt:SSOR,
~~~:~i%~~C~ COUNTY, rLOK~~A: - 244g6~
Tlii, i~ my d.rlar.~tion ot~ Domicilc ~s~~! C'itiren.hi~~ in the Statr of Florida that l am tiling this day in
accorclance, ,ind in conformity witli Scrtioi~ ~".17, Florida Statut~s.
! was fornierly a hgal resident of ~,~!E!5~~1~~~_----~~~"-- and 1
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r~sidrd at ~L,~ ___Q~D_ _~_0_1~1~ /1L-~C----_-~.~___,-_---_.. Howe~~er, t h:~ve rhanged my domicile to
(Strnrt and Numbrr)
and atn and h;~ve brrn a bona fide nsident of the State of Florida since ,2~f11~~~1`~day o1
1~--- , 19_7Q__, a~~d 1 r~sid~ at,~711_$--~1~~~___f1~
(Sttert and Numbr~)
l~Q~- ~1~1~ L ~ - Count Flonda,
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a*~.;~ ~~~t.~.,,~_„t tn h~ i,,ken ;~c my declarstion of citizenship, actual legal residence and domicile in the State
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~InseN hrrr any pertin~M facts. such as sale of ptoperty ur businrss, ur re?inyuuhment of employment a! formzr
domicile, rrmu~al uf family to ne~~~ domicile, purchasr of home, etcJ
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244965
1 FURTHER CERTIFI' tliat ! wil! mgister at my local address H~hen the registration books rcopen, and
comply with all other requircments ot~ a Irgal r~sidrnt of ti~is Statr.
I FURTHER CERTIFY that I ha~~e nc~ intention to return to m~~ former domicile, and 1 intend to rrmain in
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Florida, p~rniancntly, t~+r.?
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.9$,wt.yn to ana'~[tFi~crib~d bc t~urc m~ thi~ ~ ~i,i~~ of
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~Notary Public tS atr of f 1i i a at La:g.
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~ty Commission cxpir~s n~ - _ 1 ~ - ~p~ d00K~rVJ ~tf~9~
(Tu br .~rcutrd i~ duph.atr anJ ~~riiin.d liled Neth ('Irrk ('ir:uit ['uurl. anJ Juplicatr aith Tax Asseswr)
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