HomeMy WebLinkAbout1084 D~claratio~ ot Domiaii• a~d Cltis~nahip xU 3058
TO THE STATE ANO COUNTY TAX ASSESSOR, ~
Sl. tUCIE COUNTY, FLORIDA: ~ ~
This is my decluation of Domicile a~cl Citiz~n:hip in th~ Stats of Florid~ that I am filirq thi: day in aooordanw a~d
in aonfwmity with Chapter 222, Ssttion 222.17, Florida St~tutes.
1 wa: formerly a Isyal resid~nt of
~ Kty) (Stat~)
and 1 ~esided at ~o~ ~~*-~.~-~i L~ • . Howe~eer 1 hsve chan~ed my domid~e
(Street and Numbei)
ro a+nd am and have been a bo~ea fide msident of the Staro of Florida sinoe ~l~ ~y 7D day of
o?~ , 19~, and 1 raide at ~,~0.~• ~/~x~cd •
(Stroet and Number)
FORT li~CE, SAINT LUCIE COUNTY, RORIDA ~ .
a~ this statemsnt is to be taken as my declaration of citize~?ship, actual legal residenos and domidle in the State of Horida.
qnsert here any pertinent facts, such as sale of property or business, or relinquishment of employmsnt
at former cbmicile, removal of family to new domia{e, purchase of Iwme,. ett.)
203058
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~ 1 FURTHER CHtTIFY M~at 1 will aomply with all ott~ requirsm~nts of a lepal ~tdent of this Stste.
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~ I fURTHER CERTIFY that 1 have no intention to ~etum to my former domicjle, and I intand to remain in FORT
a
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
JOHB J . SUC~IEH
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~ ~~'~jrd``suhycribed before me this day of . 19~.
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~ UERK CIRCtMT COURT Notary Public
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~ By 1- M- ~.C. My Commission .xpiros
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R~ b~ ~x~cvl~i iw ~pilcal~ awa eei~al A~ whb CIMk CirwN Cewt, asd ~piicaN wilb Taic A~~a
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~ a~~1$9 ~1081
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