HomeMy WebLinkAbout2672 i
. ~ ~ .
Deciaration of Domicile and Citiienship
TU TEiG STATE ANU? 'OUNTY 7'AX ASSF SSOR, 2?~Q641 ~
~~.Gt-~_ COUNTY, FLORIUA:
Ti~i~ is my dreiaratioi~ U~ I~viilit;ili aiiii ~ilif'.~iiJi~~~ in t1:e ~.:.te u~ F!^~~~~i that I~m filinQ this dav in '
accorcl:~nc~, ai~d in conl'ormity with Scction ~~'_.17, Florida Statutes.
~ ~ i
I was formetly a Irg:~i residcnt af ~ and I t
~c~~~-) (s ) ~
t
msiiled at _ . However, t have changed my domicile to "
1 rt and N~) r~ ~
:~nd am and have brrn a ona tidV tesident of th~ State of Florida since ~ day of
, , ~ i
/ G~ , ly~~ , and t r~side at ~ _ c~
~ _ _ _~e~ / ~ t • (Strer d um
Y '1"~ ~ . n ~fCl I
;,c~.i.r.~ ~ County, Florida, }
- {C'itY1 - - -
~
and this statement is to be takrn ~s m~- declaration of citizenship, actual legal r~sidence and domicile in th~ State ~
of Florid~.
(losrrt hrre any prrtinrnt facts, such as salr ot pruprrty ur business, ur relinquishmenl of employment at formrr
dumicile, rrmo.ai ui family lo new dumicile, purchase of home, rtc.)
~~,~17~~,~~ ~"C-~'t" n' ~'t' ~f~f x
~~/~~r~~` ycL~-,~, ~
~~~'~vY-x- ~V
,
~/~A • ~
(~/~SY.
~
ST
LUC1E CO MTY FLA.
ROCER ?OITRAS ~
CIERK CIRCUtT COtIRT -
RECORQ YERIFIEO -
. DEC 11 12 oe PM '73
3
~
k 2'70641
~
~
~ 1 FURTHER CERTIFY that i witl rcgister at my local address when tlte registration books r~open, and
~ ~omply with atl other requirements ef a legal resident of this State.
! FURTHER CFRTIFY that 1 a no intrntion to return to my former domici and 1 intend to remain in ~
~ ~Q l ' C~.L. ~Y .C.c~
: J~f C•~-~_-- ' County, ~
€ - - ----~~~~i,~~ -
f~londa, }~ermanently. {
_ . ~
, ~ " ; ,1 ~ ~f.:JI~~LL.t.Il~ i
t _ . ~ . J'. ' _ - (Name) ~
~ y~ .s L_
t?, ~ • . ' , jt / f _ . _ T
_ , (AdJrruj 3
~ ~ r.~'•......••••'•
- SvOO~t~CcFanOSnibscribed bcforr me thi, ~ J_ d~iy of
. . .
: . .
; . . ~ ~
Y
G~C
_ - - _ A. D. 19 _ - ;
- - --ROSER PO~TRIS, Geril ~ ` ~
~
- - - - ~
- y~~~ ~ 8o~K221 F~~2671 ~
: - _
~
q (To be rxrcutrd in Jupticate anJ ur mal fi1rJ actt ('Ierk fircuit Court, and duplitate xith Taz Assessor) ~
~
~ , ; _ - i