HomeMy WebLinkAbout0357 Deciaration Dor~icile an~i Citize~ship
TO T E STA ' AND COUNTY TAX ASSESSUR, ~+,48~;~'~
a
_ COU1vTY, FLORiUA: ~
This is my dretaration af Domicile 3Rd Ct~iZ4'11~I11~ i» the State of Fiorida that 1 am filing this day in
acconi;~nre, und in ~onlormity with Section 222.1', Florida Statutes.
t w~u formerly a lega! rrsident of , _ and 1
tcity! (state) -
msided at ~-~~t.____~iv-~;_ . However, 1 havc changed rny domicile to
(Street sm! Numbcr)
and am ahd havc bc.tin a bona ~de rc~sidcnt of t:~~ State af Florida since .~L~~ day of
~ ^
. 19_~?~., and I reside at ~~~~~o
~~~%~vv.~.~ _
(Street and Numbe~)
~'i~ ~-'`-~''u'~--- - . - ~ ~ County, ~lorida,
(City )
:~nd this statemeitt is to be taken as my declaration oi~ citizenship, actual lega! residence and domicile iii the State
of Florida.
(Insrr: hete any. pertirtent facts, such as sak of property or businrss, w relinyuishment of employment at former
domicile, removal of tamily to new domicile, putchue of home, etc.)
~..E~!/-I-t_-Q.tir..fi~ .
!/''I~~~~L
/~G~-,.~.
F~~~ ~ ND RECOROfp
ST. lfJCic COUptY FL~I
ROCFR P~tr,~~s t~
Rf.CO~~~ Y q~ f~FO ~OflRt ~j
~ ~
FE8 i~ 8 S3 ~y '~3
248~~
1 FURTHER CER77FY that I will reeister at my local address when the registration books reupen, and
comply with all other requirements of a legal resident of this State.
1 FURTHER ERT[FY that ( h:?~e na intention to return to my former domicile, • nd I intcnd to remain in
- - , .
- - - - • C ount~ .
Florida, permanently_
- v -2"'~-~"-Q"~_~~-~%-- _ _ -
(Iv~m~3
~/OfS~N~
.
~a• . ~ ~ -
,`+,i; C .
~ • . - - _
U~'•,, tnaa~zu~ -
: L;•,..~;__~~~„~'•`.!y
c ~
:~&S~~rorn~to,and ~ubsct~ed bc fore me ti~i:: . Jay ~f ,
••~-~`.~c.~="c ~ ~ - - - 4-D- ~ .
l t~~• ~~J.~'_~.~_ ~~i.4~' _
^ / O
. c ' R06ER ~BiTRRS~ ~1e~it
'~ty Commission expires_____ _ ~
jTu (+e exrcuted in dupl~.atc anJ urig~nal f~lyd NitF t'Ierk Circuit Coutl, and dupluale w~th Taa Assessot}
~ ~~1 r~~E 358
. - :
. . .