HomeMy WebLinkAbout0273 u,
Declaration of Domicile and Citizenship ,
"~U T'tlt~. STATE ANU C'OUNTY TAX ASSESSOR, 2~~r181 ~
:
~`r ~ (~.~~_E' COUNTY, FLORIUA:
Tl~ix is my decla~ation of Dc~micile and Citizenship in ihe State of Florida that 1 am filing this day in
accorJancr, and ~n contorniity with Section ~~?.17, F[orida Statutrs. ~
. ~
I was fornierly_a leaal rcsid~nt oi ~'f~~1~1~- -,~15-~-~~J~~~I a~id 1
(City) (State) ~
e
r~sideJ :tt ~~ci~~ -~Q1QT-L~-~S.~-C-~-~-1'~~ • However, 1 have changed my domicile to f
(5trrrt and Number) ~
and am and h:+ve b~~c n a bona tide r«ident of the State of Ftorida since T• day ot ~
2
~ ~ , 19 and I reside at 1-~-~2._L~n~-y~ ~ ~E ?
_ (Street a~d Number)
i
f-- ~ _ County, Florida,
~_1~C~~-- - .
~C~ty)
and this statement is to be taken as my decl:~ration of citizenship, xtua! legal residence and domicile in the State
uf Florida.
(Inseri hcre any prrt~nrnt facts, surh u sa~e of pro{+rrtY or businrss, ix rzlinyuishme~i ot employment at tcxrnrr
domi:ile, remo~al of (amil> to n~w domicilr, purchasr ot home, rtcJ
. /,ll/LLiA/N EL~I-v~f P• l~5 •.TIC'.
TIfErEs~ /+~~cl E4cr~~2~s ~
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KiMBE~Pc.y ~1R~Pi~ T~'S~ r3~~r
T~,,v,u y~~ G/7I ~ TV~..~N /.J, I~V C.~ FILii~ wM~: ':;GUROEY ~
St. lU~! : ; :uKtY fLA. l
ROI.[ ? - J tRAS ~t
~ C! EFr ; ~ : ~11i COURT
~ = ~ r i~ ~ ~ , ~ E f ~
QiIG ~ $ 15 ~
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! FURTHER CERTIFY th:~t 1 will register at my la;al address when the ngistration books reoprn. an~i -
rompiy wiih all other requirements of a legal r~sident of this State.
1 FURTNER CE•RZ'!FY that 1 have no intention to return to my forn~er domicile, and t intend ta c~mssn in
. f
--F~~~C. ~ ----~~-1•-~S~~L.~----- - County, j
Florida. pern~anently.
-
(M1ame)
_ L~o _11 G - ' _ ,~Zl~rc.,c-~--c~,----
(Address) -
:
S~vorn to and subscribed bet~ore n~e this r.i ~?~'day of `
^s~,~ - A.D. 19~~.
, ~ , ,3 , ~ .
. ~G _ i~ : 7 -
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~a~y~ e of flonJa at Large ' 1~ f ,~v
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, ,tT~~ie;uied in dapli~ale and uriginal fdrd wilh fterk Circuit C~urt, and duplicate with Tax Asseuor)
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