HomeMy WebLinkAbout0336 - - - • - _ - - : _ . . _ . . ~ . _ V\ t_.
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t3~C~ar~~.ion C~Q~~i~~~~ ~c~d ~~tize~sh~~
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'f0 T1iL' STATE AND COUNTY TAX ASSESSOR, ~
r` -t~-'1 ° COUNTY; FLQRIDA: ~ • ~ ~ ~
This is my dcclaration of Domiciic and Gitizenship in the State of Florida that I am Gling this day in
accordancc, and in conformity with Section 222.17, Florida Statutcs. €
. , , ,
I was fotmerly a legal resident of ~22lC~~~~~-~-~~ , and I
f ~,(,~..(/ld.~' ~Q . (Ci~y) atej
resided at . However, I have changed my domicile to
(Street and Number) ,
and am and have been a bona fide residcnt of the Siate of Florida since day of
, 19~y and I residc at '7~?
~/.~rl.~rr,~a-t~ ~il,
~ (Stceet and Nwnber)
v~~~- , ~ County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~ .
(Insert here any pertinmt tacts, such as ssle of prope~tr or business. or rotinquishment of employm~nt at lomur
domic~7q, reraoval of family to new domicile. purchase of dome. etc.)
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App2ying for homestead . ~ . ,
Entering children in school ;
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FILED AML~ RECORQEO
~ ST. lUC1E COUNTr fLA.
• RB.~.E=+ f01SRAS
CL£RK C:i;CUiT CQURT ~
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1 FURTHER CERTIFY that I will register at my local address when the tegistration books reopen, and
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
~ ~..~-G-LG{~ c • ~`r ~
. , County,
Florida,,Ry~;manently, ~~''r)
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,Jv`~•` ~~•'~tj ft~ ~ /I' •
y' ,J ~ c ~ t''' i -OG,, t,' , . (Name)
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~ :s _ - • r~ : C . • -
~r.~ - . ~ . ' ~ (Address)
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~~q~toandg8ti.sci-ihed before me this day of _
_ ~~''~r~;,: A.D. 19~.~' . .
1toGER PO RAS, CIERK CZRCUiT COURT .
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