HomeMy WebLinkAbout1389 - _ _ i..•
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Dec~~rai~Qn af t3omic~te a~~ Ci~ize~~h~~
,
TO TIiE STATE AND COUNTY TA,Y ASSESSOR, '
. • ,
~
_S7'r L~~:~ - - ,
COUNTY; FLORIDA:
. .
This is my dcclaration of Domiciic and Citizcnship in the Statc of Florida that 1 am filing this day in
acoordance, and in conformity with Sectior~ 222.17, Florida Statutes. x~
I waS formerly a legal resident of ~e ~u~vy~.~jus Q~t ~ b ~
~ f (cxir) ' (sar.) and I ~
resided at ~=3a 5~rf
~Ng ~1 ~UE . . However, I have changed my domicitc to
(Street
and Number)
and am and have been a bona fide residcnt of thc State of Florida since /r s day of
u 19 7 ~J ~ ~ Ui l/a
~ S ~ , ~ and i reside at ~ ~ ~
/ ~sm~:pa H~,~~~)
~1crJS~.°'rl ~e0i C~l, cS~ ~ u _ i- County, Florida,
(cnr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. .
(Iaxrt hae sar perlinent f~cts. such ss sak of praperty a busi~ess, o~ relinquishment of emplormeat at lormer
domic~le. ~emaral oi fsmity to new domicile, purchase of 6ome, ete.)
. ~ •
Applying for hamestead . -
~ Entering children in school :
, ~ ~ - ~
Ca~cvav~ar y -
~i ~ ~Pv' f? Qnli'1/~ ~e~ r~ ~
! .
~ ~
~rrt/es l~ ~ //~a,~, ~e, ,
, j' - _
LED A~1p R~~ RDEO
~ _ ' wc~c tov~?~r ~t~.
. ROC~B FOITR~s ~
. CLEF,~-;,~ ~,CUtT CGuRT •
qcr,~RD VE~~F~EO
Auc_ t3 I0 49 AH'13
~ . 26~g
. 1
I F[JRTHER 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.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~~r7 se n veo~ c~ 4~ ~ie councy,
Florida, perma~ently. tcnr) '
4.~.: ~
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,,..•~~v ~r ~ ` ' .
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: 4~: y~1Vt'ti~: ~ ~S,'~ (Nsme) ;
~ ~ ~r:../~'(i•~~ -
: a~: S'~~ ~•`-t-.!~ : : ~ • .
. s (Address)
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:'a~' ~t1[~ ~ ~ ' ~
% ~ •.3` ~:y~',• i Q ~ `r. ,
-:Sb~tro t~;te~$d~t~d'~tiefore me this day of -
~
`~t~~i ' . _ . ~ ' ' :
i `.1~~~.~ _
i~~ - A.D. 19~~. • :
~ k
4 1 A ~ •
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1tOGER P4ITRA5, CLERK CI CUIT COU~2T oR~Z
6~
tiy D.C
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