HomeMy WebLinkAbout1395 . s~._ ' ~ , ~
Dec~a~a~~on o~~ t3Qr~ic~i~ a~d C~~~zer~st~ip
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TO THC ST E AND COUNTY TAX ASSCSSOR, ' 2~1~r,
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' COUNTY; CLORIDA: ~ ' ' •
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This is my dcclaration of Domicile and Citiacnship in the State of Florida that 1 am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutcs.
l was t'ormcrly a leg resident of ~ ~~~~~~~=-d , i~~~t~.o - and I
(Cltr) (Stace)
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resided at 3-3- 7 ~ ~1.~%ve , However, I have changed my domicile to
(Street and Number) ~
and am and have been a bona fide resident of the State of Florida sincc day of r
, 19_~3 , and 1 reside at
, (st~~~.~a ~me~~~
~a~y~ e County, Florida,
and this staiemeni is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. '
(lnsert here sny pertinent facts. such as sak ot prope~tr or busincss. or ~elinqulshment of employment at tormet
domicdq. temoval of fsmily to aew domicJe. purchsse ot home. ete.)
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Applying for hoA~estead _
~ Entering children in school :
,
;Ztt
C E CO~NT
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RQCER POiTRAS ~
CLERK CLiCUIT COURT
• RECORD YE~?iF(Fp,~~
.o-,~. " A~c f3 i I 24 AM'13. ,
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I FURTHER CFRTIFY that 1 will register at my local address when the registration books reopen, and
comply with al! other requiremenis of a legal resident of this State.
I FURTHE CERTIFY that 1 e no intention to return to my former domicile, and I intend to remain in
. ~y , .
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=~-G~~-! , County,
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Sv+iocr~~tnr,~~s~dbscribed bet'ore me this day of ~
. 6 .
A.D. 19_~.. •
120GER POITRAS, CLERK CIR UIT COURT . ~
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