HomeMy WebLinkAbout5557 Declaration of Domicile and Citizenship
TQ THE STATE ANU COUNTY TAX ASSt~SSOR, 2453'71
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~'*t .'`u'~-~- _ _ CCIUNTI', FLORIDA:
This is my d«laration of Domiritr and Citizenship in thc.• Statc of Florida that 1 am filing this day in
.iccorda~TCe, ,~nd in conlorn~ity with Scrtion '~_'.17, Florida Statutcs.
1 was forn~erly a Irgal resident oi' L~' and 1
(Ci1Y) ~ • (Stat/)
resi~i~~d at . However, I havr changed my domicile to
(Strret ~nJ Numbrr) .
c?nd am and have becn u bona tidc residrnt of the Staie of Florida since 7~day of
_ - - . 1 . _ - antl I residr at / ~ ~~.~t~iriL~.f
t-`r~ (Street and Numbe~) ~
.
_~a~~ -~`..L'`'~--~ • ~ --~--1 County. Florida,
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and this statement is to bc taken as m~~ declaration ~t' citizenship, actual legal residence and domicilc in the State
ut~ Florida.
(Insert herr any prrtinent facts, xuch as sale e~f proprrty or Ausinrss, or retinyuishment of employmrnt at formrr
domicile, remuval af family to nr~v domicile, purch•rce oi homr, rtr.)
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2453'~1
F LED AyD RECOROEO °
S~. lUC1E COUNTY F~A.
ROCER :~iTR~IS
CIERR GF,CUtT COURT
RE~~pD v~p~~lE~~.~....
.1u~ 10 I 3o PM'73
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1 FURTHER CERTIFti' that 1 will rc~ister at my loral a~ldress when thr registration baoks reopen, and
cornply with a11 othrr requirentents c~f a Ie,~c1l fcSltll`Ilt 01 tI11S St;llt.
1 FURTHER CERTIFY that t have no intention to return to my Former domicile, and I intend to remain in
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F{orida, permanentl~. ~r~'>>
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~~~L'v~1 to a~fisu~scribed hrforr m. thi~ c~f
~ - - - - - .~.u. i 73 -
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.Z a~.~ lc~' . Cd--c./~c.~ ~ - - _ _
- Notary Public S o( Ilurida at l ar¢e
;~ty Commission cx ire ~~-'L~'- ~ S-_ ~ y? ~
(To br ratcutrd irt durliaatr anJ ~.n.rnel filyd ti~ith t terA ['irruit Court. rnd dupliratr w~~th Tat Assessor) .
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