HomeMy WebLinkAbout0948 • • s / / ~
STATE OF FLQRiD/~ ~ ~ ~
cauNnr oF sT . LuczE~ '7:38~'71
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Th~S Is my D~cla~atlon of Dom(~1i~ In tAe 3tite of Florida thet 1 am t~linfl this dey in accordance ;
and in contw~+~N with Sectlon 22217~ Florida Statutea. ~
~ (We~ 'Lk..S _ i
tRr~x ?ian,roun wurE au~?n
b~cams a h~~ f~~a rssl~n! of t~ 3tat~ Qi ~Ic~rida an~, S~.p"~' , lg -7 7
~ ~ 14 S~ ~.-i ( ~
and i rosioe ai ~ ~ -
in the City ot-__~r ~ S{ ~.~Uc.?~
My mailir~g addrsss !s: a~~ I
t~ o~ssE~ fnor sratsT ~ooR¢ss?
S~~ a~~~ F~ 3345`7
My tormer !~i roald~nce was in the Cit~? o! o~ 1 0~ ~ E ~neC.i St-
.
State ot ~or i c~c` ~ ~`S
(No tu~ther stateme~t ta roquired How~sver. N y~ou wiah, you may insert any psninent tacts
such as sals ot propstty or bwtr~sss or relinquishment ot empioymen! at tormer domiclle, removtl ~
of tamity to ~ew ~rnidls. pu~chsse ~ home~ stc.) ~
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! FURTHER CERTIFY 1 wtti com~ily wlth aN requirements of a legal resident of this State. !
understand thero is a penalty for perjury; pe~ury is a Fetony and is punishabte by Incaratlon in the
~ State Departmsnt oi Comscttons.
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PRINT NAME SIGNATURE
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P~~tTNT NA3~ S IGNA RE
~ THtS SPACE FOR RECORDING INFORl~ATIQN
s~worn to ~ne suacr~d b~ton nN u~s ~~r •S5 (~C 23 A 9:09 ,
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~ ~~~N~ ROG~i _
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ROGER PO RCL'IT CT. ST. LJ~'~-
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By ' G ~386'71
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. !GC/. c0o Mf TP~S~'• \O~ ~
•-4 ep Clerk I
f ~~~NTY,F~~P
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Notary Pub lic, State o.f.
My Como~ission exnires :
FoaM 2o nK Q~
w~w. ~o,.., w~c ~~e. ( s e e~~ 600K ~QU PAGE
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