HomeMy WebLinkAbout1696 DecE~~at~o~~ of Dor~~c~~~ and Cit~i ;nst~?~
1 u"t~ill: S'TATl: A\U ('OUNTY ~'AX ASSt.SSUk,
sT. LUCIF. , : 2~6123
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71~ia is my ~Icclaralion uf f)rnnirilc and Citi•r.cnship in thr Statc of Floricla ihat 1 am f3ling Ihis cfay in ;
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r~~nlancr, an~t in confurmity with Scrtion ~'3. ! 7, !~loricla St:itutcs. ' '
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! ~vas fonnrrly a Irgal rrsidcnt of _ _ , _ ~ ~ an~ 1 ~
^ (cily) (sute) ~ i
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r~~~idrJ at 15~~ __~1____. ~-2?t-~s~'K-E~ . Howcvcr. I havc changcd my domiciic ta
(Street anJ Number) '
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~~nd am and have bcen a bona fide resident of ihe State of ~lorida since ' day ot'
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;~L~~ , 19~~ and 1 rrsidc at - . ~Cti ( l-'c-~_ ;
~ ~ ~ ; (Street and Numbet)
~ County, Florida, '
(c~iY)
:~nd tliis statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State ~
a1' Florida. '
Qnurt here any pertin~nt tacts, such as sale of property or busineu, or telinquithment of employment at former
domicilr, removal ut famity to ne~v domicilr, purchase ot home, rlc.) ,
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ENTERING CHILDREN IN SCHOOL: ~ NOMESTEAD EXEriPTIOri:
If entering children in school,
please list their names: 1
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MA~r ~ ID 50 AH 'T~I
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I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
romply with all other mq~~ircments of a legal resident of this State.
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I FURTIiER CERT[FY that 1 havc no intcntion to return to my formcr domicile, and I intend to rem.~~~• in ~
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Florida, permancl~tly. cc'~r) i:
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S~ti~oris'~O~td.~ybs~d before mc this ~J`- day of -
c ~ ~ ~ ~ n. n. i ~_74_. / ~5 , ~~'a~°~ G'~ ~ , }
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ROGCR POITP.AS, CL~RK CIRCUIT COURT ' , I'lorida
I3y Deputy Cler'~c -
(Tu be raciul.•J i~ du~:h: ~~c :wd uri~•in.J f~la•d ~tiith l'Icrk ('ircuil ('ourt, anJ duplN-r1r Hilh Taa Accr~s~ir)
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