HomeMy WebLinkAbout2250 Declaratio~ of Dornic~ie and Citizer~s~ip
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TO'f E: STATE AND COUNTY TAX ASS~SSOR,
_ COUNTY, FLORIDA: ;
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Tliis is my dcciaration of Domicile and Citizenship in the State of Flotida that 1 am filing this day in ~
accorciance, and in confonnity with Section 222.17, Florida Statutes.
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1 was formerly a legal resident oi' , and I
I lCitr) tstate) ~
r~sided at . However, 1 have changed my domicile to
(Stteet and NumbFi)
and am and have t+~e~~ a bona fide rrsident of thc State of Florida since day of ;
S~;XrQ.J~L+ _ , 19_7_
~2__, and 1 reside at ~ `
~ ~ (Sc~eet nd Djumber)
~ ~ ~ - , ~ ~ T-~~s - County, Fbrida, !
(Cily) .
and this statement is to bc taken as my declaration of citizenship, acti~al legal residence and domicile in the State ;
of Florida. ~
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(tnuri here any ~tinrnl fscts, sucb as sslr of property or business, or rclinquishment of emploYment at former M
domicJe, remoral ot family to new domicile, purchase of home, etc.) #
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'~j~ Fit.~o,~~o s~coaoEe
v ST.lUCIE ~OilNTrFtA.
ROC~r ?Ot~RAS
CtERK Ci :CiIIT C011RT
P.ECOR^ Y~~Ir~~p~~
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M~ 9 i os PM'73 }
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~ l FURTHER CERTIFY that ! will register at my la:a1 address when the registration books reopen, and
j comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that 1 have no intrntion to return to my former domicile, and I intend to remain in
f . County,
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Florida, permartcntly. ~c'',~>
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. ti. : y f L• I (Name) ~p R ~
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~~worfi GD ~eta s~flbed before me this ._.9 day of ~
.
. ----A_D. 19~3--
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: Notary PuMic Sh~ of orida at Largr
/~__/y73
Ny Commission expires _ _
,i (To ecute~l in duplicate anJ original fil~d w~ith Clerk Circuit Court, and duplicate with Tax Assessor)
~oox 2i1 Pa~~ 2248 _ _ ,
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