HomeMy WebLinkAbout0648 Deciaration of Domicile and Citizenship
TO HE ST TE AND COUNTY TAX ASSESSOR, , 24~191
~ -
T__ ' ~_COUNTY, FLOR~DA:
This is my declaration of Domicile and Citizenship in th~ State of Florida that I am filing this day in
accordance, and in conformity with Section ~22.17, Florida Statutcs.
1 was `ornierly a legal resident of ~ - Z~ and I
~p/~ (c~~r) (s~a~e~
nsided at -1L. . However, 1 have changed my domicile to
(Street and Numbe~)
and am and have been a bona fide resident of the State of Florida since l~~ day ot~
, , 19~ and 1 reside at ~ Q~!~~~'~ - v / ~ -
Q,,f~ (Street and Numbe~)
ot~~ eLf~~$.. County, Florida,
(c~tr)
and this statement is to be taken as my declaration of citizenship, actual legal residence ar~d domicile in the State
of Florida.
(Insert here anp pertinent facts, such as sale of propertY or business, or relinquid?mrnt of employment at fotmer
domic8e, temoral ot tamily to new domicile, purchase of home, etc.)
C h R~s ~o 1
G~c~o k a
fILEO ANO RECQRCEO
ST.lUC1E COUMTY flA.
, ROCER POITRAS
' CtERK CInCUI? COURT ~
; RECORD YER~FIEO
k
~ ,I~ 11 2 oa PH'73
~
:
~
~
~
~ 24~b~.91
~
I FURTHER CERTIFY that 1 will rrgister at my local address when the registration books reopen, and
~ comply with all other requirements of a legal resident of this State.
~ I FURTHER CER at I have no intention to return to my fo r domici ,~nd I intend to remain in
~ ` County.
- (c~~~)
Florid~,- pe~anently.
~ ~t ~ - .
~
• ~,t •i A
G.',......., ~ ~ _ - - - - -
~ • .r
j~ . ~ . (Name)
z~ q= ~v1 _7"~+u s K o
. .
u,. „ ,
, : ~ ;
~ 3•~='' ' -
~ ~ • ~its • ; ~ . ~ ~ = (Address)
~ ~ . '
_ i :~'fJf , 3 G S -
' ~ , i l'1 ~
SwOC . o and $I~t~dbed before me this day of
~ ;'.~a"•- • .
. iF` - -
- . A.D. 19~~
~
~`i lcr CL
Notary Public St e Flonda al LarRe
U: " / r
My Commission expires_ ~
~
(To be rxecuted in dupllcatr anJ urigin~l f~led with Clerk Circuit Court. and Jupl~caie with Tax Assessot)
~ • BOOK 210 ~AGE :
~
Y
~ ' t=
~ ~ ~ ,y , x ~ e._ . . . _ . ~ f f' ~i~NS
'~~~".,....~~„s: C _ _ _ ~n....~i1"`~,~'_,~'.-Y~~~~2,