HomeMy WebLinkAbout2391 249452
~P.~IMYt~lqtt Df ~DZ~ ~ ~xTii fQ~t~Ett$~i~J
To the State and County Tax Assessor,
ST. IACIS 1~1 COUNTY, FLORlDA
This is my Declaratio~ of Domiciie a:.~ Citizenship in the State of Florida that 1 am filing this day 1n accord-
ance, a~d in confo~miy with Section 222.17, Flocida Statutes, as amended by Chapter 26896, taws of 1951.
1 was formerly a legal resident of-------_-----I_at~?1'atiCet?ille Natit_ Jsrse~?---.--
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and I res~ded at --------------198 _ Carter. RoadL _Laxrence!ville~-- Na±±__Jsraa~r-------------_-------
be...t +nJ Fhrml»r S.id GeY .ed S,.~e
Howeve~, 1 have changed my Domicile to a~d am and have been a bona fide resident of the State of Flo~ida
since Noqambe~'--2---:----- daY of - ]9?~---, and I reside at
IAt__~2~ _Holida,y__Out~__on__Autchinson__Ialand~ St. _Iucie_______~ Counry, Flor~da,
sn~a .oa Nwnbe. ~;,y
and this statement is to be taken as my DeclaraYion of Citizenship, actual legal residence and domiciie in the
State of Florida. (Insert here any pertinent fads, such as sale of property or business, or relinquishment of j
employment at former domicile, removal of family to new domicile, purchase of Fome, etc.)
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-Hav~-$a1.d~ept_Nsot_~Isra~pr--home_in_f,hs_fa11~f1Rb4,---and-n~--b~ain~ss- ther~a---------- :
.s~n_~Iu1Y-3Q•--152?_4,--asra__hatto__~}~e~t__ th~m~jQt~~r_-!~--~_tfmn_Binc~thsa__Lreat~llin~-
~n..our__~~r_ . h~r~.e.- ---Ne-- dis~--t~_o_~_~eta_rQ#.urn~Nslx .~Te~~r_--~a~o~s~n_13QY.__i<Xl-2~.----T '
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I Further Certify that I will registe~ at my local address when the registration books reopen, and eomply ~
with all other requirements of a legal resident of this State. ~
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I Further CeNify that I have no intention to return to my former domicile, and I intend to remain in
ga?
~ a,~v Ou~. ~tahinson I~land~St.__~1~~ Covnty, Florida, permanently. ~
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Name - Husba
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~.vorn to a?x! subxribed before me this 1_ ~a.~?_ day
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Nvtary ~ulil~c or•qt~er pfficial taking Acknowledgment
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~ ~ - , 249452
BoaK 2~.1 FAG~ 2389 _
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