HomeMy WebLinkAbout0955 ~erl~r~#ioYC of ~ ' ' '7U1041
STATE OF FLORt~q)
OOUN7Y OF ST . LUCIE
?Ais ta my Declaratlor~ ot Domtdts i~ the State of Fio~ida that ~ am fifing this day tn accordance
and in confo?a+iN with SeCtlon 22217~ Florlda Statutes.
~,tW~~ _ ~~np_ ~ ~.~c~cacX~.ta~
• tv+~~?ss w+wt rour~ wwg ~~n -
bscame a bona tlds rosid~nt of the 3tate of Florida on.,~ ~ 7~ ,
$nd 1 roatde at_ TO rfK.~~ s R t/~t w~
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in the City ot___ ~r'~r~ P~p r~ 1.~3/~
My ms111np addreaa !x
a~aent Fr~wr s~~ ~oonESS~
My tormer le~al resldence was tn the Clty ot ~~s~_
State ot ~i_n
(No tunher statemsnt is requlred How~ever, M you wish, y~ou mey tnsert any perttnent facts
such as aale ot property or buslnegs or relinquishment of employment ai former domiclla, remova!
of iamily to ~ew domicite, purchaae of home. eta)
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1 FURTHER CERTfFY 1 wilt compfy with a11 requirements of a Isgal resident of this State i ~
unde~stand thsre is a penalty for perjury; perJury ta a Feiony and ia punis~abte by incaretlon in the
Stata Departmant o! Comscttona.
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PRINT NAME S NATURE
PRINT NAME SIGNATURE
TNYS SPACE FOR RECORDIHG INFORMRTION
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swoni to itia s~t»c~bso ~ton m~ tnts .,.L~_1 ~say '85 ApR 12 P12 :54
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' ROGE~~ • ;
BOC;EIt yP,DI~~S s,CLERK CIRCL'IT CT , ST. i ~{C!!_ _
f By. - ° ~7U~041
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. ~ Deputy Clerk
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Notary Public, State o.f.
My Comaaission exvires ; . . .
FoarN 20
~a~,,..~,»~.~. csea~, a~~~K461 P~~E 954
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