HomeMy WebLinkAbout5920 Declaration of Domicile and Citizenship
"CU TFtt: S'CAT~ ANU CUUNTY TAX ASSt:SSOR, f
~ %~~5Ei$3 ,
_ _ CUUNTY, FLORIDA: ~
F
Tl~is is my drelaration ot~ Uomicilc and Citizenship in the State of Florida that I am filing this day in ~
arcordance, and in contormity with Sertion Florida atutrs.
1 was tormerly a legal r~sident oi~ - - • , - ~ ' .~nd 1
y (cilY) ( te~ '
rrsided at ~ 3°~ / . Howc;ver, 1 have cha ~d my domicile to
-
~ (~trert and Number)
. , . , ~ -S da of
and ~m and havr b~cn a bon~ fidc res~drnt of the State ot Flonda smce •-f-- y
- -~.Q~ ~ - _ . . 19 _ and 1 reside at -l~ ~ 5--~~~l~
~ (Strtet and Number)
- - - County, Florida, ;
_ %!~[.u'~ . ~ -
~
- (Cit. ) _
and this statement is to be tak~n as my declaration of citizenship, actua! legal residence and domicile in the State
ut~ Florida.
(Insen here any prrtinrnt facls, such as wlr ~,r ~~~~~r«r or buciness, ur relinyuishment of employment at fotmer
domirile, removal uf family to ncw• dumirile, purrh~sr ot home, rtc.)
{
l ~
y~~'u ~ ~ ~
~l
f~tfD AAf+~ pfCOA
~T.IbCIE COUMTY#i~
ROC~R POITR~S'~.
REC RE~ yfR~~
iE~ COUItT ~1
~ S~ AM' ?
13 ~
f ~
f
~ %~45bs~
~
~ ~
t ~
~ _
~
~ 3
~ 1 FURTH[=R CERTIFY that 1 w~ilt register at my loral address when thc registration books reo~en, and
~ co?nply with all other requiremrnts of a Iegal resid~nt of this S[ate_
~
~ 1 FURTHER CERT Y that a~• no intention to return to m fornier domicile: and l intend to rc main in
.
~ ~ T ` ` ,~~e-t.c_R~ • - - - _ - - - - - . ( otint~
r•. ~t'~---- -
~ - ~ - -
~ Florid~,~P~Ti~}~,nently. ~c~~~•?
,
~ . f.1. 1;~~.''~s ~
, .VA
i n
~ ,
~ ,
' ' , : -~`~x -
; . , - : . . ~ - -
-
. .
, .
- _ ~ ' pT/'. 'p~ ~ , t~vam
~ '
: N. ~ = - ~ ; '
- -
: _ . _ : _
d c~~ ~
~ ~ . _~1~
. , • G . - _ _ _ _ _ _ - - - ,
-T = Av B e,l - IAddress)
' i ~ r
p3 ~~+f~~}~tb~tt~~~scribed befurc me this ~la~• of
; , , ,
? «
- , - - - A. D. 19~~.
~
/ f~
- - - - - - -
_
~:s ~ lVotary Nub ic State uf F7onJa at Rc
~ .
~
:~fy C'ommission expires_~-- ~ C - - - ~lOOK • O ~'~Gf ~O
~
(Tu br a trculed in dupGralr anJ ~~ri~~nal filyd with l'Irrk ('itcui~ Cuurt. nnd Jupli~'atr wilh Tax As~essor)
'2>
s;.''
tk ~
R~3 . . . . . ~ - . ~
c=-
~-»r',.-r~. ~ - ' - ' - . _ _ _ . _ _ ~ : . .