HomeMy WebLinkAbout0951 ~ ~ Deciaration af Dorn~cile and Cit~z~nshi~
TO THE STA1~~ AND COUN7'Y TAX ASSf= SSOlt, 248~9
4S~ ~ ~L/
~ COUNTY, F!_()RIAA: ~
This is my drelaration of Domicilc ai~d Citizriiship in the Statc of Florida that 1 a~n fifing this day in
accordancc, and in conformity with Section "'2~. 4 7, F(orid~ Statutes.
7
1 was formerly a legal resi~~nt of _~A.~3.#~t~3~_..-- -•-~a2~1.~, and 1
n tc:?t ) (sa~e)
residc;d at . However, [ nave changed my domicile to---
(Slreet and Numbrr)
and am and have bc.~en a bona fidr rtsid~nt of the State of Florida since ~ ~`'~day oi
p~X~- - . 19 r and 1 r.sid~ aL __~1~1~,~ j~~ ~-r-l , ~C~
, , > . {Street and Num~er)
- ~-.s~+l ~-~-~'-~-P _ County, Florida,
(ci~r>
and this statement is to be taken as my declaration c~f citizenship, actual legal residence and domicile in the State
of Florida.
{Insert here any p~rtineot fxts, such u sate o[ property w busincss, ot relinquishment of employment at focmer
domicile, removsl of family to naw• domicite, purrhasr of home, etr.)
~ rn a~
. J ~~~~.L
FtIED AND R£CO
sr.~uciE aow,nr~. ~t
Roc~=. a~~rn~s 1
Ctf~tK C!~Cdtt COWtT ~y~
RECORD vfR~F1E0 l'
fEe Zb ~ 3? ~i!'73
. 248399
,
~
i 1 FURTHER CERTIFY that 1~vill reg;ster at my tacat address when the registrati~n books reopen, and
f comply with all other reyuirements af a legal resident of this State.
~ 1 FURT CERTlTY that t ha~~ no intention to r~turn to my former domicile, and I intend to remain in
i , .
' _~ac~°~ ~
- Coanty.
i Florida, permaitiently. ~
~ -~i~z~~~~..~~--~~~~~%'~.~.ti
(Name)
i -
' (AdJreu?
; • .
; S~yorn to and subsrnbed bet~or~ ~ne this day,.oN•'~'~?i+;,;f~~~.,r.
A.I). 19 ~~~uE ~ '~~,`r ~
:
; -
~ ,
E ~ ~ .
`LRi1k__-_ _~_~~i~G• ' ~ t~ L, 1'
- ~•~'T ' • . ~ ~w J~
~ f~,~4.';~-~~ '
' ~is~ c~ v - - v------ ~-=-'~~#~J~'~'~.c~~~~~
, ~ ~
i " . ` •~.c~y,
(To br e~rcutrd ~n duplicatr an~f nr.~in.tl tilyd ~N~.CItt~C~tAl1"A Ovurt, and duplicate v~ith Tax Asussorj
3ao~~'.~1 ~~f 9~;
- - - - - _ . . _ _
N. . _ . . . ~F~~,. .