HomeMy WebLinkAbout1542 De~~~ratian of ~omiciie and Citi~~enship
"fU TNE STATE ND COUNTY TAX ASSESSOR, 2~~8~~
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~ _ G~~_ COUNTY, F LORIUA:
Tl~is i~ my drelaration of !)omicilr ~nd Citinnship in thc St~~te of Hl~rida that 1:~m tiling this day in
accor~lancr, ~nd in conforniity ~•ith Section '__"_.17, Florida Statutes.
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1 was fornierly a Icg.+i rcsid~nt at' - - -~~'I.~~~------- - • - - -s=~!
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tc~~~~~ cs~~~r~
r~siJed at _~L y-- ~~_~ri!'~i6_n-_-~1~e-- . Howev~r. 1 have changed my domicile to
ISUrrt and Numbr~)
,~nd am aitd have lx~cn a bona iide resident ot~ the State of Florid~ since __-s~~~_~da~~ ol
---rP L? - . 19. 7,~ . ;~nd I r~side at __~~_~!.~.~.~G~--- - -
(Strret ~nd yumbr~)
~oR-~ - p1f-~ES~ _ • County, Florida,
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and this statement is to be takrn as my dcclaration of ritizenship, actual legal residence and domicile in the State
of Florida.
(Insrn herr any prrtinrnt facts, wrA u vlr ~f pruprrty or businrss, or relinyuishmrnt of rmplo~ment at focmer
domitile, rrmo.al uf family to nr~~ dumicilr, pureh:ur ot homr, rlcJ
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J~?~,Ps
J f~v G ~ FILED ~k" ,~f~uRDEO
J` St.IUC:E fi~UxFY FIA.
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~ I FURZ'i1~R CERTIFY tt~at 1 will r~gister at m~~ local addrecs ~vheiz thi registration hooks reope~~. and
romply with all othrr requirements ot a le~~al resid~nt ot this State.
~ 1 FURTHER _ IFY that 1 havc no ii~trntic~n to return to my fornier do i~ilc. ar~d 1 intend to remain in
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~ Sworn.to~~nd subscribrd before me this da~~ of
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~ 1540 .
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~ (To be r~ecuteJ in duplicalr anJ un~inrl tileJ ~~~U~ t'Irtk Circuit C~~ur1, anJ du^twate w~th Lx Assessixl
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