HomeMy WebLinkAbout0478 . .
~eclara~ion of Domicile ant! ~itizenship? `
TO Tti~ STATE ANP COUNTY TAX ASS~.SSOR, ~
~ ,
~ ~ CO~JNTY, FLOP.iDA: f
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Tt:is is my d~claration oi~ Uomicilc and Citizenship in the Statc of Florida that t am filing this dsy in
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acc~reianc~, and in contorn~ity with Seeteon 2??.17, Florida Statutes.
! was i'ormerly a I~ga! r~sident of ~~c~-~-~ ~ v ;~A~-~ c-Q~L and t
1 / (c~~v~ ts~a~~~
msidrd at 7_~~~~sG~~~ G--d- . However. I have changed my domicil~ to
(Si~ert anJ Numbtr) _ W ~ _
and am and have been a bona fide resident of the.~~f Florida sinc~: day ot'
_ . 19 _,C,~, and 1 resid~ at ~
4 ~ • -rr ~ .1-~~~~c
e-f'
1 (St~eet and Number)
• ' - • ~ ~ ~ - - County, Florida,
(citY)~
and this statement is tu he ta~en as my derlaration ot citizenship, actual iegal residenc~ and domi~ile in the State
of Floricia.
(inseri tirre any prttinrnt facls, wrh a~ sale of p~operty cr businrss, or relin~uishment of employmrnt at former
dornicJe, rema~al ut famely to nrw domicile, purchue of home, elc J
~~z-~`- ' v,,i,u ~-!'f`MUa..~~.. c~
~
~r ~yc ~ECO~a
st i~c~: ~ av~rrir
RO~i = :'3tTR~S
. CLERK ~ ~:~~~i CpuRT ~
RECOF,~ VE~::F:ED
Ff~ Zo I I 33 ~H ~r3
~
t FURTHER CERTIFY that 1 will register at my local :~ddress when the registration books reopen, and
compiy with all other reqvirements of a lega! resident of this State.
\~j FURTHER CERTIFY that 1 have no intention to retunz to my f~rm~r domicilc, and 1 intend to remain in
~ , :
_ ~'c'~L" ,~~c-LC~-t_ County, ;
Florida, ermanenti «~"y~~ C12~c+eti etd
P Y- ~eRNfVG
~JZ~~ ` - ~
(tVame)
r\`~~ `r V f i,• e~-~?-0... ~~~+V'~ k
,v '~'J~., CG"•. (Address)
; ' .S ' .
Sw~'r~~to and s~~~ed before m~ this (J elay of '
- > > . . -
• v~ ' o : _
C:~7 =
_ . , ~r: A. D. 19,1
r. ~
. f~~. ~ : . ~O~i~- 0 g ~ .
-~-F ~ • - - ~ eoo~~ r~ 4?8
' . i
' . , 's~- ~ ~ ~ • ~ - $
(To br e~ecuted in dup.~catr and origina IrJ a+ith CfrrA Circuit Cour1, and du~+licate with Tax As.ussor)
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