HomeMy WebLinkAbout5135 Declaration of Domicile and Citizenship
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7~U Ttll: S~~A"Tt: A~l) ('vUNl~Y TAX ASSt~.SSOR,
`:b~~ . ('OUNTY, FLORI[)A:
Thi, is my dcrl;~ratiun ut' Damirilr un~ ('itir~~iship in the Statc oi' Florida that 1 am tiling this day in
arrur~ai~c~. :~nd i~i ronCormity with Srrtion ",.17, Florida Statut~s.
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I was tonnrrly a I~gal rrsidrnt ot~ 1} t4.S-~- Z--~
Q (c;»•? lsie~~~ ;
• ~f~~ G_o Yli! __~C'_- . Howcv~r. I have ch;~nged my domicilc~ to ~
r~ii~l~c1 at
(Strcrt anJ Numbtr) •
and am ancl havc U~rn a bona iid~ r~sident of the State uf Fiorid:~ since day of
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t- - . 1~) and 1 re~ide at ~e ~P S a~ C<!!~ o ~3~ ~t:i~ i
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_ - - - _ • County, Florida-, ~
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and this statrmrnt is to br taken as nt}~ declaration of ~itizenship, actual legal residence ~nd domicile in the State
ut Florida. ;
Ilnsrr. hrrr any prrtin~nt facts, surh a, ~alr uf proprrly ~x busmrct, or rrlinyc~shmrnt uf rmploymrnt at former .
Jumicile. rrm~~~~l uf family to new dumicile. purchas~ of home, rte.1
va J~I ~ 1PS ~a,,
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F~~p AtID RECOROfO
' iT.111C1E COUM?Y fl.l?. `
ROSEF FOtt4t!?S ~
' qECOR4 YER~f t£Q COUII?
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~ l f=URTHI=R CI:RTIFY ti~at 1 will rrzister ,it my loral a~ldmss whrn thr r~~istration books reopen, and
~ ~um~~ly ~~-itf~ ali c~thrr reytcirem~nts ~~f .i le~al r~si~ient oi this State.
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~ I F['RTHER Ct~RTIFY that I h:i~~e intcntion to rrturn tc~ my fornicr domi~ilc, and l intcnd to remain in
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(Tu hr r~rcuteJ ~n diy~l~:~~r anJ ~~n~inal fdrd a~ith ("lerk ('~rcuit Courl. and duplirate wrth•Tax Assessor)
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