HomeMy WebLinkAbout1592 Declaration of Damici~e a~ Citizenship
Z'O THE~TATL: D COUNTY TAX ASSESSOR, ~4~8s~
,
COUNTY, FL4RlDA:
77iis is my drelaration of Domicilc and Citizcnship in thc State of Florida tttat I am filing this day iii
accordan~ti, and in conformity with Section 2'2.17, Florida Statutcs.
I was formerly a legal resident of _ and !
tc~~Y) (su«>
nsided at ~yG~G~C--~ - Howe~er, 1 ha~e changed my domicilc to
(Stteet and Numbc~)~
and am and h~ve been a liona ~de rrsident of thc State of Florida since ~ sr day of
, 19~~y ~nd 1 rc~idr at i~ ~0 ~ //d. ~3c.t ~ S"~
/'J . J~streelaoa Tlomeer)
/
7` .~f~4Lt~l - - - . ~ ZL-GI COUtlty, F~OTId~,
(City)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insrrt here any pertinent fxts, such as sale of ptoparty or busintss, ot relioquishment of employment at (ormir
domicJe, removal of family to new~ domicile, pucchate ot home, ete.)
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tC~.£R~ L`i;i:`Jf'l (,'~T r'
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~ 1 ~ 59 ~ '13
~ 24~8s~
1 FURTHER CERTIFY that 1 will cegister at my lorat address when the registration books reopen, and
comply with all other requirements of a legal rrsident of' this State.
~ 1 FURTHE CERTIFY that 1 havc no.intention to return to my former domicile. and 1 intend to remain in
, i,~ GL.~
, County,
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Floric~a _p~rmane'ndy. cc~~Y>
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' : _~~}f~~i; ,.i~-~: 1 (Address)---------
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~~1y~yrt? ~ an~~,u~scribrd before me this day f
. 4 ~'1`~~
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~ A.D. 19_1 _
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(To be rxecuted in duplicate and uriKinrl filed «'ith Clerk Ci~cuit Court. and duplicale with Tax Assessor)
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