HomeMy WebLinkAbout1750 25~314
Deciaration of Domiciie and Citizenship
TO THE TATI: U COUNTY TAX ASSESSOR, '
. ~
_ COUNTY, FLORIDA: ' '
This is my drel:+ration of Domicile and Citizenship in the State of Florida tliat I am Cling this day in
accordance, and in conformity with Section 222.1?, Ftorida Statutes.
~ ~
I was formerly a legai resident of _ u~J ~~Yk and 1
(city) (State)
resided at ~~7~ ~A-St ~v ~ . However, I have changed my domicile to
(Sueet and Number)
and am and have been a bona fide resident of the State of Florida since 5 day of
, 19~~ and I reside at ~~`OS r> t~l' V~
(Street s Numbet)
~ ~ ~ ' ~ G l ~ . ~"l ~ V C ~ County, Florida,
(citr)
and this statement is to be taken as my declaratior~ of citizenship, actuai legal residence and domicile in the State
of Florida. .
(Inseri Aere any pertinent facts, sucA as sale of ptoperty or business, or relinquisAment ot employment at totmt~
domieile. temovsl of family to new domicile, pwchsse of home, etc.)
Applying for homestead
Entering children in school : f
tY"
~ ~i~~iuc~ c~t~r~u, ~
. AOCER r0111tAt (
CIERK CIRCtliT COU~T .
RECORD YfRIf1Ep
.~f Z~ 3~ ~'7~
25'7314
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
r,~ I FURTHER CERTIFY that I have no intention to return to my former domicite, and I intend to remain in
~F~~c-~ • l.~ 1~~. ( ~T - -•--.-~-G~_ , CountY~
Florida, permanently. ~~''y~ y jZ r Z Mn N
l , r. .
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= .,,~i~~ ~ ~ Q : = - _ tAaa~~~
' ~ - ~.-~~~~~:!D =
Sw tc~~~iiti~ ~efore me this ~ day of .
: .
~ ' C• .D. 19y~~ .
' ~ f'~/r~nne....•••
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F~GER POITRAS, CLERK CIRCUI COURT
Bv u. c s°ooK ~15 ~~c~ ~~4 7
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