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Declaration o# Do~~cits and Citiz~nship
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7~0 THE STATE AND COUNTY TAX ASS6SSOR, , .
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1 L. V G 1 E cpUNTY, FLORIDA: ~ "
This is my declaration of Domicile and Citizcnship in the State of Florida that 1 am filing this day in ~
accordance, and in conformity with Scction 222.17, Florida Statutes. ~
1~ t' ~J y0 c~ K iJt'vV d t~ 1~ and I
I was formerly a legal resident of ~ ~~~a~
~d~ ~p LL ~ V C ~ ~ ~ S , However, I havc changed my domicile to
wa H~meK)
and am and have been a. bona Gde resident of the State of Florida since day of
M ~1 R G ~ - , ~ 9~, and I reside at ~ ~ ~ 8 ~ ~
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~b~t ssd Numbee)
k' ux~o ~'K . 1~1~'TKCr SA i r~ 1 L U L1 ~ County, Florida,
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and this statement is to be taken as my declaration of citizenship, actuat legal residence and domicile in the State
of Florida. ~ •
pnsert Aere anr pe~tinent futs. s~en as sak or pwPenr o* a K~~u~snmene ot emp~ora+enc torae~
dpmkie; tea~oval ot t~mitr to new domicile. Putchase ot haae, etc.) ~
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Applying for homestead ~
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Entering children in school : ~1a '
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with ~ll other requirements of a legal resident of this State. • .
I FURTHER CERTIFY that 1 have no intention to return to my former domicile,.and I intend to remain in
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1 L ~I G.1 E --s COUntYs -
~ Florida,.Permara.cn.Eiy. cc+~r)
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`~~g~ • sd before mc this ~ day of ~
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~y{~ ~~t' ' ~Z~f7 ' 1~,~/~~~`i~~ ~
_ .:_•,~t~,~~~~'~,~a` rt - A.D. 19~ ~ ~ .
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ROGEB P(3ITRAS, CIERK CIR UIT COURT ~~c.~~~ ~~-"J 3 3~-~ 6 ~
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