HomeMy WebLinkAbout1272 t~eclaration of DomiGile and Citizenship
"f0 T: STAT ANU CUUNTY TAX ASSESSQR, ~
' 248~S6
COUNTY, FLORIUA:
Tl~is is my dcclaration of Domiciie and Citit.enship in the State of Florid:~ that 1 am filing this day in
acconiancr, and in confornuty with Section ~~?.1 Florida Statutrs.
t was formcrly a leg;~l resident of .~a _ ~ ,_~iC~i' and I
~c~~>>' . cs )
nsided at ___~G~ _ `~___s~~~However, 1 have changed m~r domicile to
(Sttce d Num )
and am and have b~~:n J bORil fide nsident of the State of Florida si e~~ day of
t~, ~
- 19--~.~, an residr at CfOG(~c~~ ~/'G'
~ _ ~ ' .`~S~`!"f " ~/e~~'C~ t:od Number)
County, Fiorida,
tc~~r)
and th;s statement is to be taken as my dectaration af citezensh~p, actuai legal residence and domicile in the Staie
of Florida.
(lnserl here any prrlinrnt tacts, such u sale oi p~uperty or business, or relinquishment of employment at former
Jomicile, removyl uf family to ne~~ domicile, purchase of home, rtc.)
~~97Hf~-~~
S? lUC1E COtlirTY fLA.
CIERK C ~ CUIT COURT
RECQFD v,~iFlE~~
~e 18 ! i AEi '73
z48sss
1 FURTHER CERTIFY that t will rr~ister at my local address when the registration books reopen, and
comply with all oth~r requirements of a legal resident of this State.
[ FURTHER ~I'IFY that 1 havr no intentio~l to rete~rn to my fonner domicile, and I intend tv remain in
. , ~ ~
• _-a~!-~ • .~1-~ G.c.,! _ - County-
Flar;cia, pcrn~anently_
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• i i; ~ --IAadress) - - - -
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Sworn-tg:~ii~~~ubscft6ed before me this day of
- .
;
_~G~.- " - ~ = ' A.D. 19,~~
,
Roc~ eo~s; _ -
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(To be execute~J in duplicalt and original filyd with Cierk l'ircuit Court, and duplicate with Tax A.~sessw)
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