HomeMy WebLinkAbout5213 Deciaration of Domicile and Citizenship
"I'O THE STATE AND COUNTY TAX ASSt:SSOR, 245118
~~-~~v____ ('OUNTY, FLORIUA:
,
Tl~is is my d~claration ot Domicilc ;,na c?c~-..~~„n~~ in the Stat~~ of Fiorida that l am filing this day in
accordanc~, aiid in cont~onnity with Section '_"_.17, Florida Statutrs.
I was fornierly d icgal rrsident of _f!_~~-~-- .~~`~L"--_ and 1
. - (C:it (Slate)
resic~ed at L~ . Howcver, I h:~ve changcd my domicile to
(~treet and Numbrrj
and am and have been a bona fide resid~nt of the St~te vf Florida since day of
~i 19~ y, and I resiar ac ~!-3__~E~ s~ :
. .
reet and Number) _
- L- ~~LU' • ~ • -~-t-~-~- County, Florida,
ic•~~y~
~tnd this state?nent is to be taken as my derlaration of citizenship. actual legal residence and domicile in the State
of Fiorida.
(Inseri herc any pertinrnl facts, such as ~te ot pruperty or bus~nrss, ur ~elinyuishment of employment at former
domicile, remo~al of family to neH~ dumicilr, purchase of hume, rtc.)
. ~ , ~~A ~
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245118 4
~`~IE COUNTY ftE.A.
IIOCER PCITRAS ~
O~EItK CIRCUIT COUIlt '
R~OORD VfRII~IEO.~.~.~ ~
,J~t 8 t s~ PN'73
I FURTNf:R CERTIF~' that 1 will r~gistcr at m~~ Ioca1 address ~i-hen the registration books reopen, and
c~mply with all other requirements of a legai resident of tl~is State.
1 FURTHER CERTIFY that 1 1~:~~~~ no intet~tion to r~turn to m~• forn~er dom'cile, and 1 intend to remain in -
_
- ''c"L.t'GG - - - - • ~ - C'ounty,
Flcu~a: p~r~ianentl~•. ~c~'~• ?
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' O t. , _ ~ ~\ame~+_ / ~~l
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f-, (I ~ ~ - a : _ - -
`~i ~ ~ ~y (.4dJrrss)
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~'~~otp¢o~h~2~,~t~bsrribed befc~r~ me thi; ~1a~~ of
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- e'' '~.c A.D. 19~3
a-~lu.~ ~G?c=+(.~~L~
- - - - _ _ _ _
Notary 1'ublic State f Florida at 1_arce
i
~1y Commission expires _ - _ / s - /
~
(Tu hr r~rcuted io Juplic~tr anJ vnEinal f~lr~ Nilh ('Irrk Circurt Court. and duplicatr with Tax Assessor)
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