HomeMy WebLinkAbout5558 Deciaration of Domicile and Citizenship
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~ro Tttt: sTaTt: nnu c'OUNTY TAX ASSt:SSOR. ~453'~2
_ C'OUNTY. FLORI[)A:
This is my drrlaration c~t~ l)omicil~ ;~~~cl Citizcttship in tlt~ Statc~ of Floricla that 1~m tiling this day in
.~cror~lanrc, ancl in car~ti~rn~ity with Section '_'_'.17. Florida Statui~s.
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l was I~onn~tly a Irgal rc~sidrnt ot' _ _ - • _ and 1
_ (CitY) , alr)
rrsided at - - . .~~2~~__ - - - However, ( have changed my domicile to
(Strcrt and Numbrr)
and am and havc brcn a bona Cd~ residrnt of thr St.itc of Florida si~~ee day o!
G%!1------ _ _ . 19 an~1 1 rrsidr at ~n~~_
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(Streel a~d Numbet)
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• , ~ ~ ° J___ County. Florida,
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and ihis statement is to b~ taken as my drelar;~tiun of citiie~~ship, actu:~l legal residence and domicile in the State
of Florida.
(Insrn here any prrtinrnt facts, wch u sfir uf p~oprtty or Au~inras, ur relinyuishmrnt ot rmploymrnt at formrr
domi~ile,rrmo~al uf family to nr~ti dumicilr, purchasr of homr,.tc_)
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2453'72
fIIED A~Q RECOi~DEO
ST.lt1C~t GJ~MTY FIA.
ROGtit Pi:=.TRAS
CIER?~ C''CUIT COURT
pr~!?~~ vF ?~~IEO ~
,1u~ 10 i ~o Pk'z3
1 FURTHER CERTIFl' th~~t I will rr~*i,trr at m~- lo~al addrrss whrn the registration books r~open, and
romply with all other requirements c~f a le<<al r~si~lent of this Statr.
FURT CERTIFY tha 1 h.i~~~ ~i~~ int~ntiun to nturn to m~~ former ~io~nirile, and I iniend to mmain in
, ~ ~~u~~~ ' - - Courlt}-.
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• ' ~ - - (Name) ~i
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~r . .4` - /OO" _ _ _ _
~ ~ ~ •'CA : (Address)
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SwfSl~n~to':lhd subscrihrd befurr me thi, ~i:i~• of
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~~.L<< 2e~ _ _ A.1). ! 73 .
L h- <~i~'` j'.~ C~~~ ~ c~.~-
Nutary {'uhGc Sta r uf IlunJa at i arcc
!~ty Commission e~pir~s , / ~T ~
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(Tu he r~rcutrJ ~r~ Juplr. ate .+nd ~~na+n~l tiled »~th l'lrr1, l-ircu~t ('uurt. and Jupl~cate «~th Tax A~srcwrl
'3~(~~K ~~J ~1GE ~~~8
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