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HomeMy WebLinkAbout5559 Declaration of Domicile and Citizenship ~ro -rt~t- sTATt~ P~u c~ovN~~Y ~rt~x Asst~ssok. ~4537'3 //(1~` ('OU~ 1 Y. F= LORII)A: Ti~i~ is my ~trclaratiun e~f Domicilr and Citizenship in the Stat~ of Florida that 1 am filing this day in a~cor~l:~n~r, and in ront'ormity with Sertion ,,,.17. Flurida Statut~s. ~ 1 was t~ornurly u Ie~al resi~ient ot~ - -~Q..~~ -~S~ - and l (t•i~y (s~ate) rrsi~ird ~t ~~Q /~~/~+Y~-_-- -~~C~---- . How:;~er. 1 have changed my domicile to (Slrrrt and 13umMr) / / and am and havr b~cn a bona lide rrsidrnt of thi State of Florida sin •e T---_1_. day of - ~l~ ~ _ _ - . ~ t ~~~~~t~ .?t /~t8- _ - ~ `(Street and Number) _ ip'Ik1 _ . - - - • ~1-~- ~l~-~~-- County. Florida, (c~tv ) ,uid this statement is to br taken as my ~leclaration oi~ citizenship, actual legai residence and domicile in the State of Florida. (Insrr. hrri anq prrl~nrnt facts, wch as vlr uf pruprrt?~ or husinrcc, ur relinyuishmrnt uf emplo~mrnt at former domieile. rrmu~al uf famil>• to nr~c dumirila. purch~ce of homr. ~te.1 ~ ~ 1 s ~/s _ ~~i~~i~e~' ~ ~ / ~ ~ ~ !~D ~itt• a~.~ ~ ' ~1~ GOb+4c~1~ iLA: i ~ER ~G1i~,~; . c/~ ' ~~3tK ~IFCU~i ~r9YRT MC~ j $~C ~R!' iEFt; fEq~.~,~,'F ' ~ i~ 1 ~ PM'73 - i ~ ~ ' 2453'~3 E 3 Y3 $ C i • 4 ~ ~ R ~ I FURTHf:R Ct:RT11=Y that I ti~ill r<,•i~t~r at my loral a~ldress wh~n the r~~istration books reopen, and ~ romply with all oth~r r~yu~r~m~nts of a I~z:~l resi~irnt ot~ttiis State. ~ ~ 1 FURTH[:R CERTIF ' tt~at 1 ha n~~ int~ntion te~ r~turn to m}~ tomier domicile. ~nd I intend to rrmain in ~ ; ~ ~ , r _ Q~~ C/~ . - ~ CL-/s - - • County. a _ . _ _ . _ . _ ~ Florida, p~~rmanrntl}~_ ? ' / / ~ ~ ~GG~~~!l~Sl_ - - - - - - ~ Iramr) ~ t ~.i~ ~ ~ ~ ~ ?.a•~~.~~~.y~. ~ ~ ~ [ / . ~~~~~felV - . . - - J!~Y==- =V ' ~ ~ ~ " ` ~ ` " > yI l ~ ~ ~ j ; ' ~ ~ . ~ ~ ( AdJressl - :-~ao,~ g } y • ~ ~ 1 I j ~ _ ~ ~ ` S«~c5fti~'~1C` ~sub~Ccified ~rforr m~ thi. ~lay ol ? ~ LI'.;~, = ;!/~///~/n C°~w~'n/ _ - ~ ~ •~?~t,';L:~ - . 1. D. I - i ~ ~ . ~ ~ ~t'%.~~C~ - _ CG , o[~r 'uhli: titate uf i L~fl,d ]I LJf£P 3±; ~ Q ~ty ('ommission e~~,ires ~0~~ 'r~; ~~.)~c7 _s (Tu hr r~r:!~trd m Ju~~l~c:itr .~nd nn~~n.~l fil~•J ~uth t'Irrl. ('~rcuit C~~ur~. anJ Jup6.ate ~~ith Tax Ascecs~x) 'i: i t';`"i . . _ _ - y LL~ . . . . _ ~ . . - . . . _ ~ . . . _