HomeMy WebLinkAbout0283 Declaration of Domicile and Citizenship
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TO THI~ STATk: AND ('OllNTI' 7'AX ASSt:SSOR. 245919
~S L_~c.ci' - - ('OUNTY, t=LORIDA:
Il~i~ is nty drelarati~~n ot~ Uomiril~ and ('itizrnship in the Statc af Flo:i;:: that 1 an~ filing this day in
acror~iancr, and in rc~nlonnity with S~rtion ?,,.17. Florid:~ Statutcs.
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I was i~ormrrly a irgal residcnt ot' ~ f~_%'''~"'-- - • - - - ~nd 1
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r~si~icd at `3_ G~ S~ G-w.~„~s.H-~ , Nowever, l h:~ve changeJ my domicile to ~
(Strtrt anJ Numbrr)
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.~nd am and havc t~~~n a bona iidc residrnt oi thc Statc of~ Florida since j_~ day ot~
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. 19. an~l 1 resid~ at S-
(Street and Number) `
7 ~
- - - _ _ _ _ ~~k~-~-s~-___- - • County, Florida, t
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:~nd this statement is to be tak~n as my drrlaration oi~ ritizenship, actual lrgal residence and domicile in the State t
uf Florida. ~
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(Insrr~ hrrr rny prrtinrnt facts, such as wir ~~f pruprrty or Ausinrss, ur rrlinyuichmrnt of rmploymrnt at fotmrr }
domicJe, rrmo~al of (amil>~ to nrw dumicile, purehase of homr, etc.) ~
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1 FURT(iER CERTIFY that 1 will rrgist~r at my local address wh~n thc registration books reopen, aiid ~
romply ~vith all othcr requirements of a lc!~ai resident of this State. '
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1 FURTHER CI:RTIFY that 1 laave no intesition to return to my forn~er domicife, and I intend to remain in ~
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S~vorn to and subscribrd b~t~orc mr thi~ lA _~f~i~~ of
' _ A.D. 19 .
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t`~~i~de r~r:uted in Jupli:atr anJ ~~ri~;~nal f~led Nitfi t'IrrR ('ircuit ('~~url. :+nd duplic:~ir N~ii~ Tai~ ns~cssar)
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