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HomeMy WebLinkAbout5524 Declaration of Domicile and Citizenship f~0 THL: TATt: A~U ('OUNTY TAX ASSt.SSOR. 245349 ~i~~~~c-~ <'OllN'TY. FLOKtnA: 71ii, is my clrclar,~tion oi' I~omirilr :~nd Citiz~nship in tlt~ Stat~ ol~ Florida that 1 am tiling this da~~ in curor~l~~~~r, and in conti~nnity with Sertion ,,,.17, Florid,~ Statutcs. l ~vas i~orm~rl~~ a 1«al rrsid~nt ot~ _ ---~rt'!~-'f - _ . ,/~__~~'~1,-.-------- at~d I tc~~,~? ~s~~~r~ r~si~ird at _6Z6. ~.G~'ct^ _~e. - . Howrv~r. 1 h:~ve changed my domicile to ~ (Slrrrl ~nJ NumArr) :~nd am anJ h:ivr h~cn a bo~ta tidr resicictit uf thc Stat~ ui~ I~lorida since _----'7-~'--- day oi ~a l ~ . 1 ~ . and 1 rr;idr at _ ~ y' - - - - - l 3_ ~'--~li _ L~~f~ _ ~ (Strret and Numbet) _ ~ ~t rt e - ~~~t. - . (~_L+i~.'~- - County. Florida, ~c~n 1 anci this statemrnt is to br taken c?s my ~ie~laration ol citirenship, artual iegat r~sidenre and domicile in the State } ul Fioricia. (Insrr~ hrrr am prrt~rtrnt facts, auch as ~ate uf p~uprriy or hucinrsc, ur rrlinyuiuhmrnt of rmploymrnl at formrr dumicilr, trmu~al uf fa~nily' tu nr~+ domicilr, purchasr i~f hume, rtc.? ~S ,La ~ fiS `1 i iL L; ~ ~ S, ~ e°/rl c` l/ ~ ~ ~1/~ ~ S cL ; fltED ANG ~ ' ST.RO~~E CO~MTYRFLA ~ ~ ~tER ~ Portp~S RECOqp y~F jF~ COURt C~ ~ ~ ~Q 421N ~ - l3 _ 24S349 1 FURTHFR Ct:RTIFl' th.+t 1 Hrill rc~~ister at my loral ;i~ldmss whrn the r~~istration books reopen. and ~oit~E~l~~ ~vith atl c~thrr rcq~sirem~nt. cit~ a I~~~at r«i~l~nt ot~ this Statc_ 1(~t:RTNE:R ('t=RTIFl' that I ha~•c ne~ int~ntion to rrturn ta my fonn~:r donucile, :~nd I int~nd to remain in ; ~ ` . ~ i..lI._). f~ic~ri~(;r.`~~,~~»;'~.~ -~r.s.Q . ~ ~l ity ? l"I e~/l~%t~P f h , ' , ~ ~ - •J 9 , ~ : : • : ~ • ' d : pTAF~ - - - . , Y : _ _ _ (Name) . ~ ~ _ ~ . ~ a _ . ~u = / 1~ - ~ : v , s . T~~,..-~z~(--~. _ - - " y: . I:~dJre.,> _ QF~••......•'; ~.~1~ -f SH•or'h.xoF.~fd,~e+ti~-~~~d b~fur~ (Tit tlii~ 10.~'cla~~ ~t "r~~~,~, . A_,). 1 ,3 . ~S~c . [ar~ ~'uhlii S~atz of 1 londa atl r~ ]O(~ t~~~ !ii V ~ nw 1ty~ <'ommissivn r~E,ir~s - ~ - 7~ . ITu hr r~rcutrd in a~~i~~.~~. end uri~~n.d fJrd ~~~Ih l'IrrA l'~rcin~ C'uurl.:md duplicale wrth Tax Acsrss~~r) , ; , ~ . - , _ ° - ~ _ , . . ~ _ _ :`d ~ ~A~