HomeMy WebLinkAbout0184 Declaration of Domicil~ and Citizenship
TO THF. ST TE AND COUNTY TAX ASSESSOK, 24'~$8'7
~ _ ` ` _ COUNTY, FLORIDA:
'il~is is my declar~tion of Domicile and Citizenship in the State of Florida that 1 am Cling this day in
:~cconlance, and in contormity with Section 21_'.17, ~lorida Stateitc~s.
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1 was formetly a legal n~side~~t ot ~~4~: ~ •T~• . - _ and t•
ily) (Slate) ~
residcd at _~'S!~' ~~'-Z ^ . However, I have changed my domicile to '
(Stteet and Numbe~) ~ ~ ~
3nd am a~~d have ~ecn a bona fide residenl of the State of Ftorida since - 6 day of ~
/-~~.c-e~-~_,~___~ , 19 7~- and l reside at 9~0 ~~~u.~m ~t(~2 . (
~ ~ (Street and Number) !
~~c..t~~- , _ ~ ~ ~ _P~~. _ County, Florida, ;
(c~ty) ;
and this statement is to be taken as my declaration of citizenstiip. actual legal residence and domicile in the State ~
of Florida. - ~ ~
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(7ncrrt hrre any pertinrnt facts, such at sale of property ot business, or ~elinquishment of employment at fotmet
detnicile, ~emo~al of family lo nrw domicile, purcAase of home, etc.)
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fLLEO AMO 3f CD~p :
tT_ i~C1E ~Ot1NT1 fiL ~
ROCCR P0ITRAS ` `
CLERK CIR~(~iTCpfl~ '
RfCQRD YER~FIFO,~„~,~ `
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i FURTHER CERTtFY that 1 wiil register at my ::~cal address wher. the registration ba~ks reopen, and ~
romply with aU other requirements of a leeal resident of this State. `
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I FURTNER CERTIFY that 1 have no intentio~ to return to my~ fornier domicile, and 1 intend to remain in
~ ~ ~A~ ~ic-~~c~- - ~ ~~G. , County, r
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Florida, permancntly. i
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~ (Name)
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'MNN~NSINp.~ ~ -
~ S~td~~ Wt~nd sG'~cribed before me this ,S-_ ~iay ~f
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~ ~ ,4 ~G~- A. D. 19 ~
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~ o~y Wic St~te uf Flori t~ p~~
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~ o be executed m duplicate and origin~l tJeJ Nith Clerk Circuit Court, an~i duplicate with Taa Asscssot) -
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