HomeMy WebLinkAbout2134 Declaration of Domicile and Citizenship
~ 24'~~05
TO THE STATE AND COUNTY TAX ASSESSOR, ;
;
'~-~-e-~ _ COUNTY, FLORIDA: ~
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
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accordance, and in conformity with Section 2?2.17, Florida Statutes.
1 wa~ f~rm;.zly a legal resident of ,~~L/ nd I '
/ (c~~y> ( ce)
nsided at 3 ~ However, [ have changed my domicile to r
(Street and Nu ~
an am and have been a bona Cde resident of the State of Florida since day of
, ~ p~
a~ , 19-Z__y and 1 reside at g~,~ o / y-/~" .
` ~i (Street and Numbet)
/ -~-e~-~' G- , ~ ' County, Fiorida,
(c~~y ) .
and this statement ~is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insett here any prrtinent facts, sucA u sale of property or business, w retinquitAment of emptoyment at former
domicile~ removal of family Io new domicile, purchase ot home, etc.)
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24~20s
ST
LUC~E COt1MTY ft~
CLERK C RCUiT~psj~pT
Rf~OR~ VEF~FIED~~
~ S 12 k~ PN '~3
i FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTH R CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain i~:
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county.
Flg~ida~,~ermanentiy. t~~~r~
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l, ~ ~ ¢ = (Address) -
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~~,,,,~i~~;t ~ an~}.~utiscribed beforc me this day of
~ ~ 1 c
~~~rh~.rHt:~ " .
, ` ~ A. D. I 9~
_ - < ~ at_~'~~
5ule of Fiorida at Large ~ ~
My Commission expires ~ ~ ~ »Y
(To be ezecuted in dupiicate and original fiird with Clerk Citcuet Coutt, and duplicate witA Tax Asseuor)
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