HomeMy WebLinkAbout1276 Deciaration of Domicile and Citizenship ~
250'7'76
TO THE STATE AND COUNTY TAX ASSESSOR,
o~.~l_,_~(l~~ e _ COUNTY, FLORIDA:
This is my declaration of Domicilc and Citizenship in the State of Florida that l am filing this day in
accorciance, and in conformity with Section 222.17, Florida Statutes.
1 was formerly a legat resident of ~ U~c'~ir~o f n~y ,~,~i~'/!~U/Y ~ and 1
( ~~r> r (S1ate)
n:sided at _ 9~ iRc~ C~(> 1'Z 1 ' . However, I have changed my domicile to
{Street and Number)
and am and have been a bona fide resident of - the State of Florida since ~ day of
, 19~ and 1 reside at ~ 1~ 2• ~ 0 2~- s/~F~/~j~~dS
(Street and Number)
~ 1 ~ ~ ~ . ~'.~A ~ County, Florida,
tc~ty~
and this statement is to be take~ as my declaration of citizenship, actual legal residence and domicile in the State -
of Florida. .
(Insert here any pertiaent facts, such as sale of property or business, or ~elinquishment of employment at former
domicile, removal of family to new domicile, purchase of home, etc.)
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=T
~uc
~ coupri ii~
Establishin residence ~~~=R ?'~~TRAS
g c~ E~r. ~~~;cuit cOUeT
R~~r,~3 Y...:r,EC~.,~,~,~~
~ Miut 19 1 ~,s PN'73
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I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and 3
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in .
t" ~ . ~ ~li R C ~ i , ~ ~ ~ ~UG l ~ ~ , County,
Flori~Ja,,~ermanently. ~c'`''>
. • • ~
M l' .
f``~~. ...'C~cl~~~' ~
c, ,S A n : ,
J ~ (Name
- ~ ~ ~ . Earnest O Goodrlc~
' ~G : ~ _
: rr ;
~l `t3 ~ ~ ~ ~ (Addtess) -
, 'r • ~ ;
" r8yvb rr gAc~,eLbs~ribed before me this'? 9_~ day of
~ ^~q . . .
•
`~1G~~/ ~ A.D. 19Z 3_.
hotar biic $tate of Florida at Large
My Commission expires__~_=1~'_~ _
(Tu be executed in duplicate and original filed wilh Clerk Cacuit Court, and duplicate with Tax Assessor)
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