HomeMy WebLinkAbout0799 .
~ Declaration of Domicile and Citizenship . ;
252528 ;
TO THE STATE AND COUNTY TAX ASSESSOR, • ~ ;
_ COUNTY, FLORIDA: ~
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in ~
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accordance, and in conformity with Section 222.17, Florida Statutes. ~
1 was formerly a legal resident of , L-~ l. Cf /9 • and 1 '
(citr) (sate) ~
resided a~ ~~z ' . However, [ 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
~'I D'Y' , 19 7~
- and 1 reside at 0~
(Street and Number)
~ ~ • ~ , ~L~?~~-~. County, Florida,
(CiIY)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Inse~t here any pertinent facts, such u sale of proparty or business, or relinquithment ot employme~t at tormet
domicile. removal ot family to new domicile, purchase of home, etc_)
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' iT~IUC E COUMT~ ~
ROCEK POITRA= ~
CIERK C~~CUIT COUAT
. RECORO vCRsF1ED~.,,~,~~
Ant 13 8 s~ ~!!'13
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' 252528
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I FURTHER CERTIFY that I wiU register at my local address when the registration books reopen, and ,
comply with all other requirements of a legai resident of this State. i
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I FURT CERTIFY that I have no intention to return to my former do icile, and I intend to remain in !
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• , o_~} nty,
Florida, permanently. ~ G ~ c~ L L_. ~`j~'
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,`~~~~fis~.iii.:
r~ ` ` (Name)
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. C,~,, U~••.,,-. (l.CT~
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:;~y ' -~~i ' ~~s~. ~naa?~~ - -7
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~bed before me this day of
to,a~~eb,~c_ - .
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; ` {'fr.,; . ~`r A. D. I 9,~~
_ ~ t~ - QOGER ~0t1RA$„ Cie~
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!-Etrge ;
800X ~~J .PA6E ~ .
(To be extcuted in duplicate and otiginal filed with Clerk Circuil Court, and duplicale with Tax Assessor)
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