HomeMy WebLinkAbout2664 Declaration of Domicile and Citizenship
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"CO 7'Ht: STA ki AND ('UUNTY TAX ASSk:SSOR,
_ COUNTY, FI f)RIDA~
Tl~is is my d~rl.ir.~tion ot~ Uomici{r and Citizrn.hip in the Statr oi' Florida that I am tiling this day in
:?cror~lan~r. :~nd in conformity with Section 17. Florida St~itutrs.
1 was t~onnerly a Icgal residrnt of G~! ~-"`"''L''L~ _ and 1
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(~~tYl (Statr)
r~si~rd al G--~ However, 1 have changed my domicile to
(Strert and NuinAr~)
and am and ha~~e bcen a bonu tidr r~sid~nt ot~ the State of Florida since day ot
~~~,~,~.f.~ ~ ~,~3 :,~~a t r~~~~~ a~ ~a~~-- ~
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~ (Strret and Numl+er)
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~~,~~~L-_ _ _ -Ge-e'-c-C._ County, Florida,
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and this statemrnt is to be takrn as my de~l~ration ol~ ~itizenship, actual tegal residence and domicile in the State
ot Florida.
(Insrn here ~ny pertinr~t facts, such as wlr of prope~ty or businru, or relinyuishment of rmployment at formrr
Jomicile, rcmoral uf ~amily to nc.v domic~lr, purchaxr of homr, rtc.)
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ST. LUCIf ~pUNIT f«,
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~ I FURTHER CERTIFY th~t I wil( n~~i~ter .~t m~~ loral address whrn the rcgistration books reop~n, and
~ romply with al) other requiremcnts ~f a legal r~~idcnt ot~ thi~ St:~tc.
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~ 1 FURTHER ~ RTtFY that 1 hace ne~ intcntic~n tc~ return to my fomier domicile, and 1 intend to rcmain in
~ ~ /i ~ ~~'~-fJ~~ ~'c~=~C' County.
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~ Florida, permanently.
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~~tbsceibed hrfor~ m~ thi, ~ _ ~1:iy of
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- - Notary 4'ublic Stat, f Plonda :~t Larcr _
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~ ~ty Cc~mmission cxpircs _ _ / ~ ` ~
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(Tu hr e~rcutrJ in duplicalr and ~~nEmrl filed ~+itfi ('IrrA ('ircuit C'~rurt. anJ duplicate «~ith Tax ~+lssessor)
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