HomeMy WebLinkAbout1380 Declar~tion of ~omicile and Citizenship
'fU TtiE STATE ANU COUNTY TAX ASSESSOR. 2g;s'742
COUNTY, F!_ORiDA:
77~ia is my drelar~ti~~n uf Damicile and Citizcnehip in thc Statc of Florida that t am filing this day in
accordance, a~id in conformity with Section 1?. Florida Statutes.
1 was i'ormerly a legal resident uf _~?~~~'-G~~' - 'Z~ - and 1
•
(citr) (sate)
n:sided at 1~~_Nd a- Sf . However, 1 have chauged my domicile to
(St~ret and Number)
and am and havc b~~cn a bona fide rrsiarnt of the State of Florida since _ day of
. l 9~ Y and 1 nside at NF ~i~~ U~~.1 -
treet and Number)
f `
~7~~_~~, _ County, Florida,
(c~iy~ . .
and this statement is to be taken as my de~laration of citizenship, actual legal residence and domicile in the State =
of Florida. ~
s
(Insrri here any prrtinrnt tacts, such as ~alr of pruprrty ~x businrss, or relinyuishment of emploYment at (ormet i
domicile, removal of family to rte~• domicilr, purchax ot home, rtc.)
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CLF~S Ct.:~u1T ~OI~RT ~
RffOP:`. VF~~ftcp
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~ i !p ai pH '73 ~
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. 24~'~42
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t FURTHER CERTIFY that ! wiU register at my local address when the re~istration books reopen, and
rocnply with all other rec~uirement~ ot~ a legal resident of this State_
I FURTHER CE TIFY that have no intcntinn to return to my forn~cr domici e, and 1 intend to remain in
~-t~~ ~
------=G`--`--- Cbunty,
FtP~ida;,~~tn~nently. ~c~'•~ ~
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~ + ' : : . (Name
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,f • : (Addrrss)
. :e,~. ,
~ S~ro~fl'te and-subscribed beforr me thi~ ciay of
~ ~j~
---/L~~~l/l~_ - A.D. 19_~
ROG~ EOITRAS, Cletlt- - - - -
- - - i~~. ~!E l~ e -
, ~4~-£~tr~+,s~ste . _ _ - r .
~ (To Ix earcuted ~n uplicate anJ ~rtig~~ filed ~.ilh ['lerk Circui~ Court. and Juplkate with Tax A.urssor)
aoox 21~ ~~sE ,
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