HomeMy WebLinkAbout0426 ti~vVV1
Declaration of Domicile and Citiienship
"I'O THE STATE AND COUNTY TAX ASSESSOR,
.
~~~7i1' _ COUNTY, FLORIDA: ~
This is my drrlaration of
Uomicilc illil{ CIIiiCii~iii~ 1ii t~?~ S:-wt~ ~f Florida th:~t I am tiling this day in
accordancr, and in contorn~ity with Scction 2'2.17, Florida Statutrs. _ , ,
~
1 was forn~rrly a Icg~l resident of _ and 1 f
~ cil • (s~ate) 1
(
i
resided :~t _-~U_3_.''~-.----- . tiowcv~r. I have changed my dom~cile to ;
(Strrrt and Number)
1
~nd am and have bcen a bona fide resident of the Stdte of Florida since day of ~
a~~ ~ ~
-___.,y • 19_~y, and 1 residr at _ ..u..~ ~*-~-C__ _ _ ~
a Str~t snd NLmber)
~~Gl~t_~~- • -'~__Li~-~cr~ County, Florida, ~
- ~~-u,,>
and this statement is to be taken as my declaration of citi-r.enship, act!ea! recidence and domicile in the State
of Fl~rida.
i
(Insrri hrrr any pertinrnt facts, such as salr of p~uperty or business, or relinyuishment uf rmployment at formrr #
domicile, remo~al of family to ne~r JomicJe, purchase of Aome, rtc.) i
,~1i~t- ~~1.Lt-C .
Gi E
24~001
f1LE0 AMO aEC0a0ED
ST.lUC1E COUNtY F~~'
ROGEF ?OiTaAS
CIEAK CiRCIf?Z COURt
RECORD vEa~F1E0
~y 9 38 pM'~3 ;
~ ~
_ ~
~
,
;
~
~
i '
f
~ S
i
S
I
$
~
d
3
~
~ I FURTHER CERTIFY that 1 will register at my local address whcn the registration books rcopen, and
comply with all other requirements of a legal resident of this Statr.
1 FURTHER CERTIFY that 1 ha~•e no int~ntion to return to my forn~er domicile, and 1 intend to remain in
~ ,
' - ~ _ - -~`~%~'u~- - County, ~
- • -
.
~ Florida, permanently. ~
~ ,...`Y ;
. ~ S
~ ~ ~ ~ ~ - -<7 %l ~t-t~-+~~ '
~ ~ / - J`~7~d~~[.~ ~ (Nan~ I
:
~ • ~ . 4
rs~L_
.
. ~
k _ • -
.
~
~ ,
~ . -
. t t - -
, . . , : r,
_ ~
~ , ` (Address)
t
~ ' Sworn tq.~id~~tfiscribed brfarr me this day of ~
~
_ - - - - A.D. 19~-~~'__. ~
- - . ~
Notary Fublic Statr loriJa at Large
~
~ / ~
~ - / ~ (G - i
~r My Commission expire _ » ;
~ , :
~ , _ ~
(To be rxecuteJ in duplicatr anJ uriginel filed ~vhh ~ierk i'ircuit Court, and duplicate with Tax Assessor)
~:x
,'.s
6Q~M ~~0 ~Gt ~~U - . _ -
~ y r
~ . ~ ' r : ~ . ~
_
, 3 ~ _ , ? _ _