HomeMy WebLinkAbout0431 . .
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E3ec~~ra~~an c~~ ~c~~~~c~~~ ~r~~t Ci~~ze~ship .
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TO TtiE STA ANU COUNTY TAX ASSCSSOR, ~ i ;
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COUNTY; TLORIDA:
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Tliis is my dcclaration of Domicil~ and Citizenship in the Statc of Fiorida that I am .filing this day in
accordance, and in conformity with Scction 222.17, Florida Statutcs. ;
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1 was formerly a legal residcnt of ~ and I
. Cit aee) ?
resided at ~a~ . However, I have changed my domicile to ;
(Street snd Number) ~ t
and and havc been a bona fide resident of, the State of Florida since day of j
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, 19.~-, and I reside at °'~4'`'v ~ ~
~ ~ - ~ ~ (Street and Numbet) f
. ~ ~~~-G County, Florida, ;
(catir)
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and this statement is to be taken as my declaration of citizenship, actual legal residence and tlomicile in the State ~
of Florida. • 3
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(Insert here anr pertinent fscts. :ueh u sate ot pwperty or business. or relinquishment ot employment st tormet :
domic~le. removal of family to new domicile. pu~chase ot home. ete.) !
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Applying for homestead . . _ .
Entering children in school : ~
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fLEO AMU RECORDEO ~
S~ LbC1E CJ~NTY F~A.
C~EF,k Cl~~r':GUtT C URT
• . RFC(1R0 YE?iciEO
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. ~ ~ s ss aM ~73 ~ ~ ~ ~
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; I FURTHER CERTIFY that I witi register at my local address when ihe registration books reopen, and
; comply with alt other requirements of a lega! resideni of this State.
~ I FURTHER CE TIFY that I have no intention to return to my former do icile, and I intend to remain in
I ~ .-c~.c~
~ , County,
Florida, permanently. ~
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~ (Aaareuj
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Sworn;o nrid•su~?s~t+bed beforc mc this day oC
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^ A.D. 19 ~ - ~
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ROGER PO S, CLERK CIRCUIT COURT -
II ~ lv ot. l~t~.`.~ D. C n~' ~ .
Y ',~K~' J .
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