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Home My WebLink About5567 ~ Declaration of Domicile and Citizenship 1'U TN : STAT : ANU C'UUN7'Y ~TAX ASSt~.SSOR, ~ 2453`79 - ('OUNTY, F=LORIUA: 71iis is my ilr~lar.~tiun u!~ Domirih antl ('itircnship in thr Statr ot~ f~lorida that 1 ant filing this day in accor~lancr, an~f in conli~rmity with Section ,,,.17, Fl~rida Statutrs. 1 was Cormerly a i~gal rrsid~ nt c~t' ~ ~ ~ - - - • - ~ ' / - - - - - :ind 1 ~ D } ~ ~ ` (t'Ftx! (Stale) R~II~I'(1 :ll . - ~ _ _ _ . However, 1 have c ai~ged my domi ile to (Strert ~nJ Numt+rr1 ;+nei ;~m and havc hrrn a bona tidr r~.idrni ot~ the State ~i Hlorida sinc ~ L__Y.~ ay of - - - . 1 ~ and I r~ sid~ at - ~ - ~r~ - ~ (Strdrt and IYumber a/~ - 1 S~- _ - - - - _ ~ . - ~ ~ - Count . Florida (c~t.1 Y , :?nd this statrment is to br takrn as my drriaration of ~itiz~itiship, artuai legal residence a?~d domicile in the State uf Florida. (Inur. hrrr any pr~~inrnt fa.•b, such a+ salr uf ptuprrh ur husin~~c, ur rrlinyuishment uf rmploymrnt al former dumicilr. rrmu.~l ~~f famih tu nr~v dumicik. purchrse uf humr, rtc.) d c.~Y)L~-Qr~~`~~ / ` - t/ ' ST UCIE COUMT~ fL~, CLE KCC RCWT C UA~ ~ RE~ORp YFnIF1E0...~,~„` ~aw t0 2 47 PH'T3 ~ 2453'~9 1 FURTHI:R Ct:RTIFI' tLat 1 a•ill rrgi:ter at m~- loral addrrss «~h~n thc rcgistration boaks reopen, and ~om{~ly with all oth~r requircments e>f a Irial resi~lrnt of this St,ite. I FURTHER Cf~RTIFY tha h.i~~~ n~~ intenti~~n to r~turn to m~ fonn~~r~~i~•i!e•.:~,c) I int~nd to remain in _ ~~T7~ /C~~1. C,.Q C~ L~~.C.J~C.r L~ ' ('ountv. _ _ . _ _ - - - • Floricla. permai~rntl}~. ~c-~'• ~ - , - - - - - - - - . . t~.d . ~ ~ r1C , i% , '~`..s«..~~ y.~ / ~ ~ - ~I ~ ; ? .-;•4 ~ , : ~ . , • . y - _ _ - - : a:~s~ r O'`~ ^ 1~ : ~ (rlJdressl ~.~~y ' ; t5'and ~ttls~i~ed heforc tn~ thi> ~ G ~fav c~f ~ ~ _ ~ : ~r S f t9 / ~i~ c E' 1»a nw ~ """~~~JJJ/// ~ '~i~ ~ • _ ~ . _ _ . • f~.'~. ' ~ ' ~ F G ~ ~ s~~ ~11G - Nu ~y Puhl ~ St~tr of F IunJa at 1 Fr ~y ~~~~K 209 ~t.: 25~7 tity ('ommission e~~ires ~ - ""~.lJ ITu hr i~~rcutrJ in ~lu~d~c~tr :uiJ nn~ ~n.~l (~Icd ~+~th l'Irrl. ('ir.ui~ ('~~urt. ~nJ Jupl~ratr a~ith Tax Assrssot) .~~.ati~~ . . - ~ . . _ - - - E _ , .