HomeMy WebLinkAbout2340 ~ De~cl~ration of ~ornicite and Citi~ensi~ip
TG TNE STAT~~NU COUNTY TAX ASSE:SSOR, 249414
.
,.a.~,~~"-___ ? r-~! -_COUNTY, FLORIDA:
~l~is is my declaration of Domicile and Citizrnship in the State of Fiorida that 1 am tiling this day in
acrord~nce, and in conformity witli Section ~22.17, Florida Statutes.
1 was 1'onncrly a legal rc~sidc~ri of s p L~" ~ ,_~_.~E~!
[ C and I
(citY) (stue)~~`~ • !
nsided dt _ _ However, 1 have changed my domicile to
tStreet and Number)
and am and have bt~cn a bona fide nsident of the State of Florida since _~LO day ot' ?
_~'~'LA.C'~~.-_ , 19_ ind 1 msidc at ?~I 1~ 2~ S 7F !Z c F 7' j
(Stnet and Number) ;
~7~ P. e r , S f• LH C!~. County. Florida, ~
(ctic~ )
and this statement is to be taken as my derlaration of citizenship, actua! tegal residence and domicile in the State
of Ftorida.
(Inserl hen any pertinent facts, such u sale ot propr~ty or ~us~ness, or rtlinquishme~t of employment at fotmer
. domicile, removal of family to new domicilr, purchase of Aomt, etc.)
J a s e~~ t, r. ~ e L. J-~ e a o(1 c~ i
.
f3c~~ 6ar~. ~ an n }~eac~ ~e Y ~
1~ ~ ~ I~ Y9 l7. f~ v i e S ~ e a c~ ~~~1 ~ 1r` , :
~
,
F~~o ~~o a~c;,~oEO i
st iuc~~ ~OtlNrr FLA.
RtfG_F .~a:r~~?s ~
Ct'cR1~ t~:;~Uii C3URt ~
REC~;~ : •;r•:rIL~
, ;
- M~ut ~1 10 32 AN'73
24941~ -
1 FURTHER CERTIFY that 1 will recistcr at my loc:al address when th~ registration books reoprn, and
comply with all other requirements of a legal resident of this State.
~
I FURTHER CERTIFY that 1 have no intention to rettirn to my forn~er domicile, and I intend to remain zn ~
~.,~~....•~.~,~e r~ S-f `L ~ c ~ County.
~ ~r
Fto~i~a; ~en„a~j,,t13,
. . • 1 I C ~ ~ i ~ .
:r ~ -~~7 ~~±~~..t a.GQ ~ _ ' ~y),~
_ ' ..~.t., : 7~~' G : ~ L :'r~ 1 " v v-~ _ ~
A ~.~a:~'i~'~:~' •~:,iSrs.. _ (Name) -
_1 j~y~-±~; " . ~~r . : ~ ~
! ~ • ~ 7 . ~ 7
• . k~rt-~,-' d L~~ l
~t:`.'-C~
r'~'~,+~~ (Address)
Sworn to~and~subscribed bcfore me this
~ay of
~ A.D. 19_~,,~
ROGER POtTRAS. Cler~ p~ s c~
~ BUfiK~~~ P1,Ci ~JS
-1%!~_- ~
(To be execu in ~up ~cate and urigin~ filed wilh Clerk Citcuit Cnurt. and duplicate with ?az Assesxor)
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