HomeMy WebLinkAbout0901 Decl~~atian af Do~icile and ~itiz~nship
1'U Ttlt: ST l: ANU COUNTY TAY ASSt:SSOR, ~48364
_ COUNTY, ; LORit)A:
11?is is my ~I~claration uf Uom~ciic .?nd Citiu~~ship in the Statr uf FI•~nda that I am f:ling this day in
arcordance, and in conformity with Section '__'_'.17, Florida Statutes.
f w~as formerly a legal resident of -~1~!!_ , , nd (
1 (c•~~ Y 1 (sute
rcsicled :~t _ . Howcver, I have clianged my domicile to
(Strert anJ Numbrr)
and am and }lJYC lxen a bona tide r~sidcnt oi the State at~ Florida since __.L-~ day of
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19- 7~-, an~l 1 resid~ at _ I~s.[ ~1Z~ -
- (S~reet and Numbcr)
~ • - O~.L~
~ ~l . County. Florida,
~c•~~.• ~
;~nd this ctatement is to be tak~n as my declaration ot citizenship, actual legal residence and domicile in the State
of Fiorida.
(Inse~. herr am prrtinent facts, such ss sale oi pruprrty or husiness, or relinyuist~ment of rmploYmrnt at former ~
domicile, removal oi family to or~r domicilr, purchase of humr, rtr.)
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FIIEa ~N~ RECOR7F
j SL lUCif ~~J~MTY F~~
R0~[~ PO~TRAS
G~E~~( Cf=.~UtT COURT
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~ FEe 13 2 02 PM ',3
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I FURTHER CFR i IFY that I wili register at m~ local address when the registration hcoks rcoren, and
romply with all other requiremcnts of a legal resident of this State.
~ I FURTHER CERTIFY that 1 have no intentio~i t~ mturn to my former domicile, and 1 intend to remain in
, • •
~ ~ _ - - - s • County.
Florida. pcrn~anently_
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~ (Add~essl
Swor,n fo and subscribed bef~rr mr thi, _ ~ay of .
J
_ . A. U. 19 __7~- .
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- - ~a_ c..E'~ C~~'~ ~ - _ - -
Nu[ary PuMic State of FMnda at L:+rYe
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1~1y Commission erpires ~ cz ~u.c<<-~
~ (To be rtrcuteJ in uuplicate ~n~ untinal filrJ :~~clh ('le~k C'ir~uit Cuurt. ~nd duplkatr with Tax Asxs~ot) .
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~ 300K 2i1~ PAGE , , , , _ _ . _ ~
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