HomeMy WebLinkAbout0918 ~ DECI.AW~?TION OF DOMIC_ZLE
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To the Clerk of the Circuit Court (County Comptroller] ~ `1 County, Florida.
This is my declaration of domicile in the State of ~,1,~~ , that I am filinq
this day in accordance and in conformity with Section I~Y, ~~ori3a ~tatutes.
FOF. QOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at /3~,,7 7~ ,
~ ~ ~ , s~re~~ an num er
,~y , in .,~~,_~~y County, Florida, which place of abode I
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recoqnize and intend to maintain as my permanent home and, if 2 maintain another place or
placea of abode in some other state or states, I hereby declare that my above-described
residence and abode in the State of Florida constitutes my predominant and principal haae,
and I intend to continue it pezznanently as such. I am, at the time of makin this decl~t~~
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tion, a bona fide resident of the S ate of Florida re~idinq at 13a v,~/>.~ ~h°~o
~~street an num er
, zn , ' Cn~unty, Florida. I formerly resided at
c y ~ :
(,~,~,,t . ~.~1~~-~~ _ County, , and the
-~cl y state
place ~r places where I maintain another or other place or places of abode are as follows:
(Here Iist street address, city, county and state of any other place or places of abode.)
C~? ,~yt.~~ ~
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Z tool: up permanc~t residence in s e
~T • ~~l-'~_~d~_ Q111~~~- (print rl
tt~ state of Florid~ cxi ~
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gnature
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Swarn to and subscribed before me this ~ day of _ ~ , A. D. 19~~.
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Notary pu C t a a rqe. 19 P 3~33
i My CommissiQn .:'~li~~~~~ ~ c^ ~
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~ F`OR i}OMICZLIARISS OP STAZ`FS CTHER THAN THE STATE OF FLORIDA:
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~ I hereby declars that ~y domicfle is in the State of ~ and that i intend
~ to permanently continue and maintain my domicile in suc state. At t e time of making this
declaration I am a bona fide resident of the State of My place of
~ abode r?ithin the State of Florida, if any, is as follows: Here ist street address, city,
~ and county of place of abode in Florida.)
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~ lPerson makinq declaratien may also include such other and further facts with reference to
~ any acts done or performed by such person which such person desires or intends not ta be
$ construed as evidencinq any intention to establish his domicile within the State of Fl~rida.)
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~ S wvm to and Subs~ri~ed bcfore me this day of , 19
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~k~tary ~'s~~:i:~, S~at~~ ,F Floricia ~
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