HomeMy WebLinkAbout5395 Declaration of Domicile and Citizenship
I~O Ttit: STATt: ANU COUtiTY TAX ASSt:SSOR. ~4523,~
- ('UUNTY. FLORtt)A:
Ti~is is my drrl~r:,tion ol' Uc~rnirilr ,in~! Citiz~nship in the Stat~~ of
Florida that t am filing this day in
~~rror~ianc;r, and in ront'orn~ity with Srction "_'.17, Florida Statutcs.
I was t~orn~erly a I<gal rrsid~ nt ui~ ~(,e~ - _ ~ _ _ _ , - _ ~ and t
~
~r ~c~~r~ ~ ~s t~
4 ~
r~sidcd at~~_t1Z~Q-a_c~. _~2~,~ ~L__ . How~ti~er, 1 have changed my domicilr to
(Strret rnJ Numbrr)
and am ~nd have brrn .i bon;~ tide residcnt of th~ State o` Florida si~ ~ _ day of
/!"CJ• . 19 and 1 msidc at ~ ~_~2_~~ - ~ 70 ~t~-~~
~ _ _ 7
~ ~ ` (Street and Numbrr) C~~ '
~.~~-Gut-C - - - ~~.,6~ ` County. Florida, i
cc~~. ?
~nd this statement is to be taken as my ~icrl~ration of citi-r_rnship, actual legal residence and domicile in the Si~[e ;
ui' Florida.
(losen hrrr •rny prrtinrn! f~cts, such as vir uf proprRiy ot businrss, ur relinyuishmrnt of em~+loyment at former
dom~cilr, remo~at uF family to nrN domicilr, purch~sr homr, rtc.)
` ~ ~
G LGQ..i-~G • C/LU~~GGG ~P~Z~-~i
s
`~..~'1~.,,.-.2~ ~ r
4
~D ~~G RFCO
ST.R~F COUb7f'~~E, t~
~[FRR ~
~ ~'O~TR~IS
RE.O&? V~a ;
fE~t CO~RT G
.~M S 319 P~ ,l
~ 3
24523~,
! FURTNFR CERTIFY that l will r~;,ister at my lural a~idress ~~~hen the registration books reopen, and
~~mply with all othcr requirements of a Ic~_al r~sidrnt ot thi~ State.
1 FIJRTNER CE IFY that 1 ha~~~• n« ir~trntion to rrturn to my fornier domi~ile, • nd I intend to rernain in
; ,
: ~ .
' . - - - _ • _ _ ~~-`--1-- County.
Florida. pern~an~nNy.
~
_
. _ . .
~ . . . . c
• ~ ,
• , ~ . , ?
' _ - -
' . (Namel
•,1 O T,~j - N C 2 M 0. N S. (~.v S 7~-
, ~
-
_
_ _ _ - - -
: : ~:~aa~~ss~
y,`; U L;C ~ -
~ . ~i`~i~,tc~.~iict'`4tixribed b~t~~re RTr thi. ! cl.?>~ <~f _
~ ?
_ _ - - r ~ ~J
~
; ~ c. _ c~ _ ;
~
~ an Nuhlic Statr uf ! Iu~tJa al (_area• O~
~ - BQQK 209 ~~t,~ 23~5
~1}~ Commission cx~~irrs
(Ti~ hr r~riulcd ~n du~~hratr and ~~n~m.d f~lyd ~:ith llcrk l~irauit t'uurl. anJ dupl~.atr ~~rth Ta~ As.srswr)
_ : - .