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Home My WebLink About5704 ~ ~ Declaration of Domicile and Citi~enship j~ -rFi~~ sT~ t: nnu c~ovh~~v TAX ASSI:SSOR, ,245~85 ~ ~ ('OUhTY, FLORiDA: Tl~is i, ilty ~l~clar:?tic~i~ ~~i' Domirilr an~! Citizrnship in thr Statc oi~ Flarida ihat t atn tiling this day in :~rrc~r~lanc~. and in runti~rmity ~vith Sccticin 17. Florida Statutrs. ` ~ . I was fonnrrly a Ic~al rcsidcnt ot~ '~~1'~''`-~--~-{~ ~v ~ and 1 tc•~er? _ _ ' _ _---~s~a~~ r~~si~lra at ~ ~-fz,s,~.v `L~'`-t-_ . _ - _ . - • Now~vcr. 1 have rha~~ged nty domicile to (titrtrt :+nd NumAr~) l. .~nc1 ~m and havc hrr~a a bon~~ fid~ r~sidrnt of tli~ Stat~ af F~lorida since day Ut 6 . I~) 7~_. and 1 rrsidr at f~~'.t' --~-b_~v_~' N/,-~-l~!C S--~~i2(vF- - - ~ (Sltert and Numberj ~ b ~2 ~ L~ e~ . - ~ / -~`'-~---'L"C- County. Floricta, - - - - _ . tr~~> ~ ;~ncl this statem~nt is to he takrn as m~~ dcrlaration ot~ citizrnship, a~tual iegat rrsidence aiid domicile in the State ui Floricl~. (Insa•n hrr~~ an> prrtenrrt facts, ~,:rh as +alr of pruprrty ur businrtc, ur rclinyuuhmrnt uf rmploymcnt at tormrr dumiiilr. ~rmwal uf fam~ly [o nr~v dum~ciir, purchi~e uf home. clc.) ! ~ V ~ f1LE0 AMfl qEC~~t0E0 ~ ST_LUC1f Ci~tJNTY fLA. RaCEtt PQlTRAS CLEf:K CIRClJ1~ C0011T i RECORD vf~:~lEO Jw J 1 I i3 PH '73 245485 1 F~tTRTFil=R ('t:R"TIFti' that i~~ill r~zister at my loral a~ldres~ when thr registration boc~ks reopen. and ~om}~ly with all othrr rrqt;immrnts ~~t :i lc~al re~ident ot~ thi°, Statr. I(=l'RTHI~.R (`1=.RTIFY that ! ha~•c nc, i?~t~ntic~n tu r~turn t~ my formcr du~»i~ile. :uicl 1 int~nd t~ mtnain in ~ ~ j ~jF~~~~ S 7- ~ v~~ ~ r , - - - - - . Count~ . t=lcincl~, p~r~i~~?it•r~[h. ( `~-:-~-L`-,`. Gt' ~--c~ ~ - / ~'Vame) ~ / 1~ v ~ ~~v ~ c N~v / - _ ~ • - - - ~ ~ - ~d ~t ~ . ~ _ . ~ rc G-'`i ~ ~ ~ . ,~vvio~~.to;~~t~~;cRtlscrih~c! t?~fc~r< <~~c tiii. ~ia~~ c~f • - ~ ~ . . . . . . . - : . ; - ~ A.U. 19 ~ . -~;;i~.~ - - - l` .f~~~ -Ic >~c .t~S; I~i~tat}~n~ic S~atc I lnnda at Lar~r ~ 600K rA6E~~~ .~f~T,-~ fr~~~if~s~qi~e~{~ires_ ~ l~ ~ _ nr~~„»t~\`y: (To tk e~rcutrJ tn Ju~~6.atc .~nd „n~m.d filyd ~~ith ('IrrA l~~rcnit ('~~urt.:md dupli:atr ~vrth Tax AS(l•SSO~I rr~x .e , r . . ~ _ - . . Y - - 3:_" r.