HomeMy WebLinkAbout2217 De~cl~ration af Domccile and Gitizens~~p ~
TO T E S fATE AND COUNTY TAX 11SSESSOR, 2493~~,
. _ _ COUNTY, F LORIDA:
This is my dreiaralion of Domicile and Citizenship in the State of Florida that I am filing this day in
accorcfance, and in conforniity with Section 22Z.17 Florida Statutes.
1 was formerly a legal resid n of _ and I
. (citr) (sate)
rc:sided at 1 ~ _ However, 1 have changed r+ny domicile to
(Street and NumGer)
r
and am and have been a buna fide nsident of the State o F orida ' ce day of
, 19 ~'-1 , and [ residc at ~
~ ( lreet a~d Numbet)
County, Florida,
(c~~y)
and this statement is to be taken as my declaration of citizenship, actual legal residertce and domicite in the State
of Florida.
(lnx~t hc~e any pertinent facts, such u sale ot property or business, or relinquishment of empbyment at tormer
domicJe, removal of famity to oew domicile, purchase of home, eic.)
,
f~LEQ ~11L P.£CpROfO
st c~cr~ ;,au~,Tr F~
qCC=R F4~7R~S ~
CLfR1( C~::~Jit COURT
RECD~D y«•~r~~
~ 9 IO 46 AN '7~
, 24931~,
, 1 FURTHER CERTIFY that t will register at my local address when the registration books reopen, and
~ comply with all other requirements of a lega~ resident of this State.
~ FURTHER CERTIFY that I have no intention to return to m forme domicile, and I intend to remain in
~
_ .
~ ~ , County,
Flgtaa, ~~iia ~XIy. cc~~, • No N C v u 2 7~
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~ Sw~fn t~S~.slibscribed before me this day of
- A.D. 19~~
~OGER POITRAS~ C~ ~
--~dltl~"Pi1~ t~7t~7TCe ~
~ ~ ~ eooKzll PACf 2215
(To be e~ecuted in duplicate a d nriginal fded with Clerk Circuil Court, and dupiicate w~itA Tax Assessor)
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