HomeMy WebLinkAbout5177 Declaration of Domicile and Citizenship
TO THF STATE AND ('OUNTY TA~C ASSt:SSOR, 245091
~__I~11~i,~ COUNTY, FLORIUA:
This ss my derlar~tiun oi~ Uomicil~ and Citiz~nship in the Statr of Florida that 1 am iiling this day in
accordancc, and in conformity with Section _'?'.17, Florida Statut~s.
1 was formerlv a le~al resident of _-_4r~l2b~b1~$__ ,-IZ~1~_Y~k--_ and I
" (City ) l~~atr j
rrsidcd ~t _ FQ~1C1~riS1 ~~at~_Ii4$~l~a~___ . However, 1 h~ve changed my domicile to
(Strrrt and Numt+rr)
and am and have bcen a bona f3dr r~sident of the State of Florida since day ot
K4Y~~~r----------- . 19- and t reside at ~4~1---pr11~~~4HS1_
(Strert a~d Number)
~'t . Pierce - • - ~~~S~.f~- County. Florida,
(citY)
and this statement is to be takrn as my dcclaration of citizenship, actual legal residence and domicile in the State
of Florida.
(InsrN here aoy prrlinent tacts, such as sale of pruperty ur business, or relinyuishment of rmploymrnt at formrr
domicile, rrmo~al of family to new dumicilr, purehase of home, rtr.)
Eatabli::~hin~ rea~dence
~ 24so91
t~
IUCiE COUNTY f~A,
C~E RSC3RCUIT CO!!RT
RECORO VEP.IFIED~,~,,,,~
~bu+ 8 Ii ao AM'13 ~
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~ I FURTHER CERTIE=Y th.it 1 will m~ister ;~t my local address when the rrgistration books reopen, and
~ romply with all other requiretn~nts ot~ a I~~*al resi~lent ot tl~is Statr.
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1 FURTHER CERTIFY that 1 ha~•e ~io intention to r~te~rn to my t'orn~er domicile. and I intend to rernain in
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~ ~!t._ Pie~~e _ - - - ct.I~u~ie - - ('ountv, '
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~ FIC~(~~f: ~1vFJ~3l1~I1tI}'_
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' ~ Fl k' . ~-F Q,~,.,~,~ a•U.. t t.~,t,c,~ _ _ _
_ O n ~ - (\rme)
~J: r
= : _ Dr. Hanr.~h :~`ehler
::4 : ,7 1 G cs _ _ - - - -
~ y'. t! D t' ? lAdJr<<~?
K~ ' ~ ;
,~'~i~.~°tt~~~t~gtN~t?t'~~~d b~fore mt thi~ 8th ~lay ~f
r,~,. ~~,~~i.~~~u~i+"" :a~+ . .
-
~R ' ~~n~uary - . .4.~~. i _ 73 .
•°`c~'L ~°`-~"=`-`~`'u - - _ _ _
'~n Nutary Public State of Flnrida r~ Larcc
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~ ~ty Commis,ion exrires dt~2~ii8~'y 1 1~75
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ITu he rirruRd in duplicatr ~nd ~~nE~nal filyd .~ith ('Irrk Circuit Cnurt. and dupl~catc ~a~th Ta~ Asussor)
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