HomeMy WebLinkAbout1379 _ _ . . . . . : . . ~ . - - . .
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DecE~ra~~~?n c~~ ~o~~1C~~? Ci~I~E't~s~1i~ :
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TO Tf~E STATC ANU COUNTY TAX ASSCSSOR, '
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COUNTY; FLORIDA: ~ ~ ' '
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This is my dcciar~tion of Domicitc and Citizcnship in the State of Ftorida that I am Cling this day in ~
accordance, and in conformity with Section 222.17, Florida Statutes. {
l was formerly a]cgal resident of !Y~' 'k'' X
+ ~~~Y~ , and I
(st.te)
residcd at ~°2-~r ~'`s3F~' . However, I have changed my domicile to
(Street and Number) ~ ~
and am and have been a bona fide residcnt of thc State of Florida since ~ ~1X da of ~
- y f
Ly' , 19
7-3 and 1 reside at s~- ~?A~?~~' ~ ~P.
(Street aad Number)
QoRi"' si
' LvL,~ , Si' L.JC,r
County, Florida,
(Cier)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~ .
(insert here aoy pertinent facts, such u sale of p~ope~ty or business~ or «I[nqutshmw~t ot empioyment at torma
dom[c~. removal of tsmily to new domicJe, purchase ot dome, etc.)
i
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Applying for homestead . , ~
Entering children in school : ? ~
.J /9/`~C
S 1.~"'/~
-'x~.r"'iP _ ~P• ~
fILED ANO RECOR0~0
~ ~~~~C~ $T.lUC1E COUNTY FIA. - •
/tif ROCET ~01tRAS ~
• CLERK C~nCU1T COURT
RE~04D vE~«tE0
- Auc 13 i0 il Ap'73 .
~ 26~0 ~ :
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legat resident of this State. ~
E
I FURTHER CERTIFY tliat 1 have no intention to return to my former domicile, and I intend to remain in
lno /P: " S,'." L u c, r S: ' Lv~ , County,
Florida, permanently. ~c~~r)
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••'~~Cl:; (Nsme)
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; ~ ~P o~•::. ~a o s. 1.~.9.~..s~~ ~
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: t3. ; r ,•~i (Addreu)
-:111.`~`-~ , :
SB~fB~'g td~R~ ' u~''bod~efore me this day of .
- ne .
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: ~ ~ = y3 .
A. D. 19_
,"~~~/'ty~, ~ _ ,``r
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ROGL~'Rfa~C~xTItA~S, CLERK CIRCUIT COURT e0~~~~ r~ .
1374
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