HomeMy WebLinkAbout2303 Declarat~on of Domicile and ~~tizenst~ip
TO THE STAT~ ANU COUNTY TAX ASSESSOR, 245~~
_9~.~ COUNTY, FLORIDA:
Tiiis is my drelar~tion of Domicile and Cili~e?iship in the Statc of Flor.cla th~t 1 am filing this day in ;
arcordance, and in conl~orniity with ~_ction ~'_'.17, Florida Statutes.
1 was formerly a Icgal resident aF ~~-,~r~• ~ and 1 '
~ (CiIY) ' (Stalij
resided at Nawever, t have changed my domicile to
(S eet and Number
and am and have been a bon~ fide resident of the State of F!orida since day ot'
~~~~15~lS1 , 19__?~, and 1 residc at ___c~! !~2_.-
l (S ett and Number
~_~~!~~.,..t" ~.L.g<i.C11 ~~~_..C',G. ~ ~ County, Florida,
t~'~~Y )
and this statement is to be taken as my declaration of citizenship, actuai legal residence and domicile in the State
of Florida.
(Inseri herr any pertinrnt facts, sucA u sale ot pruperly or business, or ~elinyuishment o( tmployment at former
domicile, removal of family to new domicile, purcAase ui home, rtc.)
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Clf;x C.,:.,~~T COURT '
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M~ut 11 8 3~ AI~'73
~249388 `
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i 1 FURTHER C~R~IFY that I will register at my local address when the registration books reopen, and
I comply with all other requirem~nts of a leg;~l resident of this State.
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f 1 FURTHE ERTIFY that [ have no intention to return my former domicile, and I intend to remain in
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tJ-- - ~ ~ ~ • County,
' Florida, permanently.
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Sworu:itEra_tt~'~3ub'sc~t6ed before me thi~ J~- day of
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- -'~~,,qt~1~ _ _ ~ A. D. 19.~c~ _
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~DGtR POITRAS~S~erk.-__---
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(To bt rxecuted in duplicalr anJ nrigin~l filyd ~cith l'lerk Circuet Cnurt, and dupficate nit~. Tax Asseuor)
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