HomeMy WebLinkAbout0341 . _ . . . . _ : . . . . _ . _ - _ _ _ _ . . - . ~ k_. ,
~ ~ zso4si
De~1~ra~~Qn a~ ~a~ic~~~ ~~^~~1 C~~izer~shi~
~
.
;
TO THC STATE AND COUNTY TAX ASSESSOR, '
~ F
COUNTY; ~LORiDA: ~ ~ '
_ . • -
This is my dectaration oP Domicile and Citizensl~ip in the State of Florida lhat I am filing this day in
accordance, and in canfocmity with Section 222.17, Florida Statutes.
1 was formerly a lega resident of Q~~~ a~~~ and I
y) as)
resided at . However, I have changed my domicile to
(Street a d Numbe~) ~
and am and have been a bona fide resident of the State of Florida since day of
, 19,~3 and I reside at 14/.Z
(Str£et snd Number)
.,«..w _~-~.u.u.~
. County, Florida,
(u~r)
and this statement is to he taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. .
~
(Intert Aere any pertinent taets, sueh u sale of property ot business, or relinqulshment ot empioyment at tormu
domicilq. removal of famity to new domicite, purcAase of home. etc.)
. '
Applying for hoR~estead . _ . _
~ Entering children in school : -
Q.~~.~'-~+.~ .,~~.~v ~ ~ .
. . G~~
~ .
Q.~/ ~ K ~
2so~s1
- • ~ ' ?i~Ea a~c ~~c~Ra~ ,
~ST. L~iCtE COUytY-f~.• . '
• R4GF~ FarRaS
, CLEHK CinCUiT COUAT
RECORD y_RrFtf~,r~~
~ A~ ~ il oi A!!'13
' ~
~ ~
~ ~
; .
~ . -
,
~
~ I FURTHER CERTIFY tl~at 1 wiil register at my local address when the registration books reopen, and
~ comply with all oiher requirements of a Iegal resident of this State.
f
I FURTHER C T1FY that I havc no intention to return to my former dom'cile, and I intend to remain in
~~.~1-~-L - .c-~-cc~c-
, County,
Florida, permanently. ~~'~r~ ,
_ ~
; ~ J,~!~ ~v[ Q~ G~Yj fJ~''""_~
, , v• ~ i:` • 7~~e-~s•L~v1 ~ (Nsme~ 1~ :
y ,'~Y1-, ~ ; G ~ - ~ • ~
~ ~it: ~ _ , (Addttss) 1
Iy: ` ~ " S
,.~'~~1~vorli`~o'an~ subscribcd bcforc mc this day of
i ~ ~3 ~
A.D. 19 . '
~
; ROGER POITRAS, CLCRK CIRCUIT COURT
i 13Y Cv oic G~l~ D. C 0 R
21 ~ . . : .3~ 7
- - - _ - . '
~ _ ~ ~
~ _ ti~ ~~;~y.