HomeMy WebLinkAbout0597 Declaration of Domicile and Citizenship
TO THE ST4T ' NU COUNTY TAX ASSESSOR, 24~,~~0
.
_ COUNTY, FLORlDA:
This is my declaration ot Domicile and Citizenship in the State of Ftorida that I am filing this day in
aCCOrdanc~, ;~nd in conformity with Section 22? 17_ FIoP~
~tatt~e~/ `~~~E~~~QS7~ L, ~
3 J T'
1 was i'ormerly a legal resident of ~ and !
(city) e~
rc:sided at L~0`,~L~'~L/~T, _/~~Q
'i ~ v~£~ However, I have changed my domicile to
(Sirret and Number)
and am and have been a bona fide rrsident of the State of Florida since T~ day of
O ~11~--__ , 19~_~, and I mside at ~a0 ~cLt/A~ ~,T S 4l
(Street and Number)
' ~T ~~fi ~ - County, Florida,
(c;ir>
and this statement is to be tahen as my declaration of citizenship, act«al legal residence and domicile in the State
of Florida.
(Insrrf here any pertinrnt facts, such as sale ot proprrly or busineu, or relinquishment of employment at former
domicile, removal ut family to new domicile, purchase of home, etc.)
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st
tfJCIE C4UNTY f~A
CL RK
C RCUlT COURT
RECORp VER1F~~p~n`C
~ 11 9 as AM'T3
24fi140
1 FURTHER CERTIFY that I wiii register at my loral address when the registration books reop~n, and
comply with all other requirements of a legal resident of this State.
i FURTHER CERTIFY that 1 hati~e no intention to return to my former domicile, and I intend to remain in
~r ;
- --r-~ ~J~ County.
Florida, permanently. «"Y~ ~ ~ '
~
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• % (Name)
't:~ O~il~~ : L
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Sa>plni;~r';'~(d'~bssribed before me this day of
. ' r f r ~ .
- - - A. D. 19 f-~_.
_ ~~y~
N tary Public State of Fk a at Largc
My Commission expires---__---- - -
(Tu be executed in duplirale rnJ un~inal filed ~cith Cletk Circuit Court, and duplicate with Taa Assessor)
aoeK 2~(~ ~aCE
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