HomeMy WebLinkAbout1787 Qeclaration of Domicio~ ~nd ~itiienship
TO TNE: STAT ND COUN7Y TAX ASSFSSOR, ~48g8?7
.
_ ~ c'~ _ COU?~TY, FLORIDA:
Tljis is my d~claralion ut" Domirilc and Citiz~ii,hip in the Statc of Florida th~t t am filing this day i~t
accordance, and in cottforniity with Section ?~?.17, Florida Statuies.
1 w~es iormerly a legal rrsidrnt of t 0 ~/S~~Lt'J ~~~.t: ~nd 1
/ ~ (cil>~ ' (s~ale
rr~sideu at ~~_~~_C-~ ~'C~c%' _~1~,__~ . However, 1 have changed my domicile to
(Street aad Numbe~)
~nd am and t1JYC bcen a bona fide resident of the State of Florida since day ot
---~~~r(//'~ h = • 191~, artd 1 nside at -z
~i__ ~ _ _ /1,.0~~ s'~ / ~ g f`~
($treet and Numbet)
1 Ly7'~ -~U ! ~ S~ ' " ~c'~ c County, Florida.
tCitY 1
and this statement is to be tal:en as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. .
(Inseri hets any pertinrnt facts, wcA as s~lr of pro{+erty or businrss, cx relinyuishment of empMyment at farmcr
clomicJt, remoral uf tamily to oe+v domicila, purchase ot home, rtcJ ~
~/~,~~e.,/ _
ST~~UC
E C4UM7Y FL~.
CtER
yCtRCUiT C URT ~ l~
RECORD v:FIF1E0.~~
M~ 5 3 os PM'73
24~98'~
1 FURTHER C~RTIFY tr~at 1 wi:l registcr at my toral address when the regict;ation bo^ks reopen, and
comply with all other requirements of a lega! resident ot' this State.
1 FURTHER CERTIFY tFat 1 have no intention to return to my former domicile, and I intend to remain in
/ C ~ E'
~ ,~~=L`_ - ~ Coun[y.
Florida, permancntly. <<'~`~~
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S}vor~`r: 1 an.d.`subsFti~ed bei'ore me tteis _.~~a~~ of
` A.U. 19 ~
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(T~s Fve rxecuted in dupt~catr and orif~n~l filyd Kith Clerk Cercuit Court, and ~uplieale aith T~x Atsessor)
2~.~ P~ ~t 17~5 . _ .
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