HomeMy WebLinkAbout2237 Dectaration ~f I~omicile and Citizensh~p
"CO THE STATE ANU C'OUNTY 'TAX ~1SSESSOR,
~ ~ 249332
sS~_ c COUNTY, FLORlDA: ~
Tl~is is my drelaration oi' Domicilc and Citiunship in the Stat~ of Florida that [ am filing this day in
arcontance.:~nd in conformity with Section 2".17. Fl~rida Statutcs.
i was t'orn~cr:y a lcgal rc~sideni of - and l
0 tCicr) (statc)
rnsidrd at - ~L ~___~~t - However, I have changed my domicile to
(Strett J Nu~r)
and am and have lx~n a bona fide residc~nt of the State of Florida since day of
~y .
1_ , 19_~~z, and 1 reside at --=~SS ~r c_v
~ (St~eet Number)
4~ e~ . - -~t ~1~ County, I'lorida,
(cil x )
~~~d this statemrnt is to be taken as my declaration of citizenship. actual INgal residence and domicile in the State
of Florid~.
(lnsert he~t xay perti~rnt facts, such u sale of p~uprrly or business, ur rrlinquishment of rmploYment st fotmet
domicile, removal ot family to nrN• domicile, purchase ot home, rtc.)
/S
~Nv
LZJ~ F~tEO AyD aECOripEO
ST. lUClc COUMTY FI,A.
CLEFKC~ ;`,~O~TRAS
REC4~.^ ~ `•~UIi COURT ~
YE=••!F?_rp
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~Z 28 PN 'T3
,
2~9~z
,
1 FURTHER CERTIFY ti~at 1 witi register at n2y loeal address when the registration books reopen, and
comply with atl othet requirements of a legal resident of this State.
! THER CERTIFY tha ( have no intention to return to my former domicile, and I intend to remain in
' ~ ~ s _ -
Cc c , e_ counry,
Florida, permancntly.
..,~t'" ~o~r . t,/. - ~
J :~~s~' .w?~f iCG•.~':. (IYame)
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$w~~r?:~o an~,~lbs~~ed before me this _ day of
A.I). 19~i,~
- ,
~C~G~ - - - -
ROGFR POIIRAS_ Clerk
- -
. . ~ J.~ 80flK 211 Pa~~ 2235
S- - - - ~ -----r~ -
~
(To tre executed in duplicalr ~nJ uriginal filyd .cith Clerk Circuit Coutl. artd duplicate with Tax Assessor)
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