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Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
,
.~r.c c cc~~" ~ G~OUNTY, FLORIDA:
This is my decl~ration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
1 was formerly a legal resident of , i~G~,,~- ~rz.~- and I
( r) ( te)
resided at `1~ - - ~
. However, I have changed my domicile to
(st.ert ana Numee.)
and am and have been a bona fide resident of the State of Florida 'nce ~ day of
19t1~ and I reside at ~
.~,F, ' ~.pa H~~~~
- ~ County, Florida,
(t~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(I~sert hm aar pertiae~t fxts, such as sate ot prope~cy ar business. or relinques6mmt ot employmertt :t tormer
domk~e~ remoral ot familr to new domicde. purcLase o[ bome, etc.)
App~ying for homestead
Entering children in school :
FILED AN^ RECOROEO ~
ST. LtiCIC COUNTr flA. ~ f
ROC~R POiT~AS
CLERK Cct;CU1T COURT ~
RECOR~ VER~FI~L'~,,,~,~~
J+~ S 3 31 PM '13
2~56051
I FURTHER CERTIFY that I witt register at my tocal addneess when the r+egistratian books reopen, and
compty with aU other requirements of a legat resident of this State. .
I FURTHER C TIFY that 1 have no intention to return to my former domicile, nd I intend to remain in
i~/~ .
, County,
Florida, permanently. «'~r~ ~ ~
-r ~ / ~Q/~
~..~~ns1q .
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• ' - ~~1~ • IF ~AY~«~ ~
f ~ ~1~ . ~ '~1t
~i ~ , S s r : ~ ~ r: /
, d betore me this day of '
.
U • ' 0+;1~~~'~' . .
' ` ` _ A.n. 19 ~3
•~~NN~ ~
ROGER POITRAS, CIERK CIRCUIT C~JRT
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