HomeMy WebLinkAbout0748 _ _ _ . . . _ _ . . _ , _ . ~
. 260'~5~
~ I3ecfar~~~Qn af ~ar~icite ar~d Citize~5i~~~a
. ~
TO TfiE STATE AND COUNTY TAX ASSESSOR, ~
• F
- COUNTY; CLORIDA: ~ ~ ~ '
This is my dcclaration of Domicile and Citizcnship in the State of Florida ihat I am filing this day in
accordance, and in conformity with Scction 222.17, Florida Statutcs.
1 was formcrly a l~gal resident of ~..~a;+~r.~i , and I
ia~r) (state)
resided at , ~ . Howcver, I have changcd my domicile to
t Num j
and am and have been a bona Cde resident of the State of Florida since day of
, 19~y and I reside at d ~
(scr«c a Tluwber)
L-~u~ . County, Florida,
(~~r) ~
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 pertine~t facts~ sueh is sale of pwperty or businas. or relinquishmeat ot empiorment at forma
domic~7q. rtmoval ot family to new doaiicile. purchase of home, etc.)
~ . -
Applying for homestead . .
~ Entering children in school :
_ . 260'~5~ . .
~ ~
/ - ~ FILEO ~ND RECORDED .
~ _ ~T. tttCiE COONTY FL~, -
fIO~,En' FOITRAS
~ CLERK Ct;CUIT COURT
~ AFCORn ~c~,.ftf0
~ ' ~ I~c~ 8 9 s3 AN '73 - .
- ~
~f . ~
, -
I~ . ~ - .
~I 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.
E - -
' I FURTHER C TIFY that 1 have no intention to return to my former do icite, and I intend to remain in
~ • ~ . , County,
Florida, permanentiy. (~'`r) _
. ;;::fciA~i..,,.
~~'•'COl.' (Nsrree)
, l'.r ;.j`•~ •cC;:: .
~ ~ ~ ~ ,v~ ~ 'qG
: A (Addre )
- ;i ' ;L ~ .
; ~woin'•„~~i~~;s~i~~ii~d bctore mc this ~ day of
' '^~'~'•._s~ _ 'y'' A.D. 1 3 . .
, ' i
' ~ ~ ~ E G,,.•
f ! /~~~~~~t..~t~t
ROGER'POZTRAS, CLCRK CIRCUIT COURT . . .
13 , ~~~z.c,l~-c~i (9 ctcrGt-L~~ D. C a Rr ~l ~ P4~t ~ -
v .r~4 .
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5
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