HomeMy WebLinkAbout2737 ~ , t _
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Decf~ra~:~on a~ ~~~°~~icil~ and Citizenshsp
1'O TNt: STATI: ANL' COUNTY TAX ASS[:SSOIt,
~ t ~ ~ C ~ _ _ COUNTY, LORI UA: ~ ~
This is my drelaration of Domicilr and Citizrnship in thc St:itc of Flaricia that ! am filing this day in
accordancc, and in conformity witli Section 2??.17, Florida Statutcs.
1 was formerly a lega! resident of ~ C~ ~ G v S~ , ~`~~'qm~ and I
~c~~r) csace?
resided at l5 57~ ~~9` S~ , However, t have changed my domicite to
(Stroet and Number)
and am and have been a bona fde resident of the State of Florida since ~.~~'~~~~ay of
` , 197-3 , and I reside at /13 3 /~~2 ~ 5.~~i~2C .
/ ( reet and Number)
~ ~r~/~~~° - , ~ County, Florida,
' (c~tr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. -
(Inserl fiere any petlinent facts, sucA ss sale of property or business, or telinquishment of employmeot at formet
domicile, rcmoval ot family to new• domicile, purchase of home, etc.)
Applying for homestead
Entering children in school : ~
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; 1 FURTHER CERTIFY that I will registcr at my local address when the registration books reopen, and
! comply with all other requirements of a legal resident of this State.
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; I FURTHER CERTIFY that 1 ha~•e no intcntion to reiurn to my forn~er domicile, and 1 intcnd to remain in
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~ ~~~./G'l S ~ C/ e Co nty,
~ ~'c"`-T'` (citr) ~ /9./YJ.~Y« ~
_ Florida, ntly.
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~ \~.G ' ~.''.P/~ T¢~ (Name)
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- ~ jr ~ i ~y
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t . -'~;8~: Et~EO ar~0 RtC~ROEO j~
~ .;~Ivbr . t~t~sc~fbeJ betore me this day of ~T.lUC1E CO~N Y FIA.
~ % • . ~ • IIOC~R PC~TRAS
j < < . ~ QI~RK CIRLUIT COUpT I
A.D. 19...,~--• Rcceao vER,~~EO~
5 ~
~ ROGE P ITRAS CI.ERK CIRCUI COURT Z IZ 38 PM ~~3
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ny . n , c 25`79`7'7
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