HomeMy WebLinkAbout1496 ~
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Declaraticn of Dornicile a~~ Citizenship
TO THE S~ AT ~ AND COUNTY TAX ASSt:SSOR, 2488~'4
, COUNTY, FI.ORIUA_
'Il~is is ~ny drelaratian ot Domicile :+nd Citizenship in the State of Flori~a that 1 am filing this day in
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accordancc. :end in coniorniity with Sertion '_??.17, Florida Statutrs. ~
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1 was formerly a legal resident af and I
lci~r) (sute)
nrsided ~t • How~ver, ! have changed my domicile to
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anc~ am and have b~.~=n a bona ti~~ nsident of the State of Florida since _`~~~eb~ day ol'
- • 19 ~-L. :~nd I residi at -.~-~~-~~L _ ~O ~ i d ~ 1~- . ,
r ---l~ _ ' ~ ~ (Street s~d Numbet)
Li.r ~cJ County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(:nxr~ Aert any pertinent facts, such u sale of property or business, or telinyuist~ment ot rmpioyment at totmer
domicile, rtmoval uf family to nrvl domicilt, purchue of home, etc.)
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STLIUC E C~UHTY F~,~{~ y~
R~?CE~ ?p;TR4S
CLER!( Ct'rt;U1T ~^,OURt
RECC`!iC YEK~~~tp~
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' 248814
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1 FURTHER CERTIFY that I will rrgister at my local address when the registration books reopen, and
comply with all other requirements of a legal rrsident of this State.
I FUR3'HER CERTIFY at I have no intent~on to return to my former domicile, dnd I intend to remain in
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~ Florida, Pern~anently. ~c``•~~ -
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s'~lbStnbed before me this l___ day of
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~r"„J~!~~~~ - A.D. 19-/ -
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ITo be r~rcuted ~n duplicale and ori~inal flrJ w~ith Clerk CircuR Court. and duplicatr with Tax Atsessor)
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