HomeMy WebLinkAbout1368 De~iaration Af Damicile and Cit~~enship
2487;~Q
TO I'H~ STAT~ AIVt) t'UUN'TY 7'AX ASSL:SSOR,
COUNTY, FLORIDA:
This is my drelar~tion oi' Domicile and Citizcnship in thc State of Florida that ! am filing this day in
arco~d~nce, and in conformity witi~ Scction ??~.17, Florida Statutrs.
1 Kas fornierly a Icg:+l resident of ~'_'1i~'~' e_.~ ~Q ~ and 1
/ (L'itY) (statr)
msided at ~~t____!~
Q x.-~/?3____________ . Nowever, 1 have changed my domicile to
(Strzrt and Numbcr)
~
and am ~nd have b~~c:n a bona tide rc~idtnt . ol the State of Florida siuce day of
T J/, t
~t . 19'_?~ and 1 residr at 'e!v/ ~1/~Y ~ N~` t
~C f ~p / ~ (Street and iQumber) i
_YZ~'!J,_ ~
- - ~c~~,•?-------- - County, Florida, i
and this statement is ro t;e taken as my declaration of ritizenship, actual legal nsidence and domicile in the State
oi' Florida.
(Inserl hrrr any pettinrnt facts, such as salr of pr~~perty or businzss, or ttlinyuishment of rmployment at former
dumicile, trmo~al u( famity to new domicilr, purchase ot homt, etc.)
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iuc E couNrr ~i~°,
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CLERi~ i~.',~UtT ~dURT y~ ~
PE~Ow:t ~ra~ctE~~L'
~rr t 9 09 AN '13
248~?30
I FURTHER CERTIFY that t wiii re,ister at my local address when the registration books r~opei~, and
compl~~ with all other req.~irements of a l~gal reside~~t of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in
- ,f-c'~-'- • County.
Florida, pcrmanently. ~
.
. _ ~?'L° ____~~L ' ~'_1~-_
; , • ~ . - -
' 'i (Name)
_ ~ ' , . ~ t MES
' y'•; ~'':'j•'' ~ - ~~A i~ ~r,
. •..L - G ~ Q ~ (Address)
~'~Swo~~`at}~ s~tbSc.~bed before me this l__ day of
,t s• v
r'' ~ A.D. i9~~ -
' -
~ .ROGER ~'UIfiRAS, qefli
ibe~r-~.~iese~
. Q;e~-~-
~y-~?~~,~~- r~~ ,~.<J~~J-~p.
(To be esecuted in duplicate rnd ~~riFinal filyd Nith l.'lerk C'vcuA Court, ar~d Juplicatt with Tax .'tssessor)
o x21~ PAGt1368 , ~ ~ „
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