HomeMy WebLinkAbout0452 Declaration of Domicile and Citizenship
TO THE STAT ' AND COUNTY TAX ASSESSOR. 246019
` _ COUNTY, FLORIDA:
This is my deciaration of Domicile and Citizenship in the State of Florida that ! am filing this day in
accord~nce, and in conformity with Section 2?2.17, Florida Statutes.
I was formerly a legal re~ident of ~ 6
we 2 u h!-e _ ,~P/1' and I '
(City) (State)
resided at ~ Ff c~ However, I~have chan e~~y domicile to '
(Street a d Numbrr)
and am and have been a bona fide resident of the State of Flarida since _ - day ot'
_-~6 P yn {r e lt, 19 ~y: and I reside at ~0 ^ ' ~
(Street and u ber)
~ _e ~i~ u-~ County, Florida,
(cit y )
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Ins:ri here any perlinrnt facts, such u sale o! pruperty or business, ot relinquishmznt of employment at tormer
domicile, temoval uf family to new domicilr, purchase ot Aome, etc.)
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~ 1 FURTHER CERTIFY that 1 will register at my local address when the rcgistration books reopen, and
~ romply with all other reyuirements of a legal resident of this State_
~ I FURTHER CERTIFY that 1 havc no intention to return to my former do iicile, and I intend to remain in ~
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~ Florida, pernianently. ~c''-">
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(IYame) ~
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( Address)
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c.nbed before me this _
r; Swd~sn to ~tt~4t~'' l__ ~ay of
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- - • A. D. I 9
G ' ` - . r`~''^ _~!`~lc _ -
r-- ~ lic State of tlorid ar¢e
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~ ~To tx rtrcuted i~ duplicale and ori~:inal fded ~cith l'ferk Circuit Court. and duplicate with Tax Assessor)
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