HomeMy WebLinkAbout0438 ~
De~laration of Domicii~ ~nd C~tizens~ip
TO THl: STATE A1~D COUNTY T4X ASSE.SSOR, ~~Q$s
.
~ COUNTY, FLORIUA:
Tl~is is my Gl'CIJT:IIWiI oi Domicile :end Citizenship in thc State of Florida that i am filing this da~? in
arcorJ:~ncr, and in ~on:ormity with Section ~22.17, Florida Statutes.
.
I was formerly a Icgat rrside~ "t of ~ u 5 fa ~ c~r and I
33 ~3 O/GL C! v r e h,~aP • cc~~ (s~.~c
nsided at _ ~ However, 1 ha~e changed m~ domicile ta
(Strret and 'umErr) ~ 7rj
and am :~nd have tx~cn a bona Cde n~sident of ihe State ot Florida since day of
___EQ~ r v u_~r~~ . I q'n-~`, and ( reside at31 S g~~-o~S~' •
, (Stteet a~d NumDer)
- ~oY~__ S'~- . 1_vC~ ~2. _ _ S~ _ L vC~ e County, Florida,
~citv)
and this statement is to be tukrn as my declaration af citizenship, actual legal residence ansl domicile in the State
of Florida.
(insrri herr anY {+~ttinrnt facts, such u sslr o[ pro{?ertY or businrss, or trlinquishment of employment at to~r.ir~
domicile, remo~a~ uf family to ncw domicite, purchase ot home, rtc.)
b,~ ~ ~K~.~ ~ ~j a.,, , S
~eY~~SE ~ ~0.~hQ ~a~v~S
s~u~~ i:~i~T~r u
~f~-' ~C~TR~g
pc ~K ::~~'t COURT
. L tF ~ ~iE•,1
~a ~ ~ t!3
248085
1 FUR'I'HER CERTIFY that t~vill register at my local address when ihe registration books reope», and
' romply with all other requirements uf a legat resident o3` this State.
~
; 1 FURTHER CERTIFY that 1 have no iniention to return to my former domicile, and I iniend to remain in
~
~O ~c `l C. ~ ~ - v L.. ~ e, • Cou nty.
Flor~da. pernianently. «'r•-~
- - ~ CLi'~~--------
~~Y~ (Niame)
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.•.e...,~~~~ 't (Address)
' ' (r ij ~ 1 n
S~wt~~tst~nc3`st~~iibed before me this d_ day of
. ~Sv ~ - _ • ,v i
- 'l•;.?;
I ~ A.Q. i9,~_.
. R~~~ ea~~
- - {
; • ~ r-~op~~ic !e o orida at Lar n~/~ `/,e~' ~ /
_ ,
~ ' ' ~ . / C ~i~~
i~1y C~omm j~ion exnires----_-- - _ -
. ,
(To be r~ecated in dupl~c~te and un~:inal ~Jed wiih CIetA Circuit Cnurt. and duplicate with 7ax Auessot)
SUOK P~GE `fe38
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