HomeMy WebLinkAbout2228 ~V/'~ I /ti/V'2
Deciaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
~-G' COUNTY, FLORIDA: '
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This is my declaraiion of Domicile and Citizcnship in the State of Florida that 1 am filing this day in
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accordance, and in conformity with Section ?'2.17, Flurida Statuies. ~
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1 was form~rly a lrgal msident of ,~~%-~Ljtw • and 1 !
. cc~~r ) (sa~e~
n;sided at a-?-~-t--__ . However, I have changed my domicile to
(Stteet and Number)
~nd am and have been a bona tide nsident of the Statr of Fiorida sinc~ c~ay u`c
L
~~~~~ii . 19~-Z and 1 reside at _ ~ / ~~4i:. ~ev„r-o ~ -
treet and Number) •
~'c
t't'cZ - , ~c~,- County, Florida,
(citr )
:~nd this statement is to be taken as my declaration of citizenship, actual legal r~sidence and domicile in the State
of Florida.
(insrri here any pertinrnl facts, sucA as salr of property or business, or reiinquishment of empioyment at fotmer
domicile, remorat of family !o new domirile, purchase of home, etc.)
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24'~264
F LEG ~t~r0 RECOR EO
S~ LUCiE cOUMTr
ClE KtCir~uiT COtIRT
RFCOR~ VER!FIE~?„~~~~
FEe 6 10 Zs AN'73
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I FURTHER CERTIFY that 1 witl re~ister at my local address when the registration books reopen, and
compiy with all other requiremcnts of a legal resident of this State.
1 FURTHER C RT1FY that I have n~ intention to return to my former domicile, and 1 intend to remain in
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- • ---a~ "`'`'t-~-~- , County.
Fiorida, permanently. ~
jii = . . ~ . ~
' C .1 ~ ' : . . • Lynne (Name _
~ , W .F.
.
_ . _ G ? ' _ _ -
(l 7 j. ~ ~ ' / (Address)
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~ ; ~iuvorn.tadnjl~~t~rbscribed before me this _ day of .
~f ~ p~'~`.•~`'~, -
''~~rr~,~~ '
A.D. 19~~
_~u:.~.-~' z~a, l~~
otaty Public Siate uf Fl~~t~da at LarRc- - -
My Commission expires ~`~uc /S / 91~ , ~
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(To be axecuted in duplica~e anJ ungmal fitrd wilh Cletk Circuit Court, and duplicate ~sith Tax Assessor)
~00~210 ~c~2225 , F '
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