HomeMy WebLinkAbout2213 ~~c~ratian of Dorr~ic~le and Citize~nship
"1'O THE STAT ' ANU COt?NTY TAX ASSESSOR, 2~93~4
L;~!-C_;___ _ COUNTY, FLORIDA:
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This is my derlaratian ot Domicile and Citizenship in the State of Florida that 1 am filing this day in
acconiance, and in conCormity with Section ~'_'2.17, Florida Statutes.
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I was formerly a t~gal rrsidcnt of _ and 1
lc~cr~ (sa«~
re~sided atG~~~~_-, ~n (~~G'{~ . However, I have changed my domicile to
treet and Number~
and am and have tx~c•n a bona fide ' resid~nt of ~ the State of Florida since _ day ot'
, 19~~
/{4 and 1 reside at ---,~~--T-C" 2 C.~?~%~_..~
~ (Street and Tlumber)
_ _ • _ , . County, Florida,
(c~~Y)
and this statemeet is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insc:i here any perlinent fxts, such as sale of proporty or business, w relinquishment of employment at totme~
domicle, removai ot family to new domicile, purchase of home, etc.)
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LUC1f CflUMTIf f~A• t~~
ROGEF ?OtiRAS T ~ 1\
CI.ERK C:ACUIT COUR v
RECORD Yf~~fiEO
M~ 9 l0 iz AM'?3
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249314
1 FURTHER CERTIFY that i will register at my Ioc:al address when the registration books reop:.~, and
' compiy with all other requirements of a tegai resideni of this State.
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' RTHER ~ERTIFY that 1 have no intention to return to my forn~er domicile, and I intend to remain in
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' 1T ~ ~~_-`%~~-L _ /L~'~ u ( . Cotmty.
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"•S,worr~t~:ana.subscribed before me this day of
/ ~ 1~1=~1 - A.D. 19~.~~
ROGER POITRAS, Clerk
- ~ _ - ~~J, ~ . 8a~x2~1. ~221~
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(To t+e earculed in duplicate anJ oriRinal filyd Nith C'lerk (:ir.uK Coutt, and Juplicate v?ith Tax Assessorj
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