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288563
, Declaration of Do~iciEe and Citizenship . j.
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TO THE STATE AND COUNTY TAX AS SOR, .
G t _ COUIVT1l, FLORIDA: , , •
w_ a~ r~f L_~ i ~tiw.. ~1~i~ elsas i~
'[~I1jS jS Tll~/ (ICCIarJ~lOi1 O~ UOfl11C11C 8R~ I.lUZC11St11~ lll Ifl~ Jl`dl~ Ui i`lu1`1ud iua? i oiTi a+~+~+g ~s~.j a•+
accordance, and in conformity with Section 222.17, Florida Statutes.
A i 0 n/ A~.~ • and I
1 was formerly a legal resident of ~~~r= . •
a
resided at ~ 7 o~ 9 Q-~ ~ R ~ o a) 3 6 . However, I have changed my domicile to _
(sw~:.~a H~~e~)
and am and have been a bona Cde resident of the State of Florida since 3 day of
~ V v S~ _ 19~~ and I reside at 4~1 a{q
L t-, a a^^ p S'T •
' (Street ~ad Numbet)
~ • ~ ~ t,. ~ C~ Zi _ .S ~ • t-- V C,1 COWI~}I, ~OI1d8,
(City) .
and this statement is to be taken as my declatation of citizenship, actual legal residence and domicile in the State
of Florida. •
(~~tt Se~e any patinent tsets, tuch ss sak o( property oc ewinas. ar relinqubAment ot anploya~eat at tonaa
dpmieie; reieovsl ot tsn~Uy to new domicite. PurcAase ot Aome, ete.)
-Applying for homestead ~
~ Entering children in school : ~'~2,$ r~ ) '
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~ ~ CLERK CI~CUIT CQURT' ~
• RECOr~`~EF~FtEO,...r••~-~
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I FURTHER CERTIFY that i will register at my Iocal 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
t t 1Q C. e~ _ S T• C- t~C , County, -
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~ Fiori{ia~• pern~ar~ently. c~''r)
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.Swo .n~tQ aQd s~t~~scribed before me this ~ day of ~
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~ A.D. 1 Y ~
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~ ROGER P TRAS, CIERK CIRCUIT COURT d~~ ~1~~ ~
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