HomeMy WebLinkAbout0993 ~ecl~rni~aa uE ~mr.i~itr S"
ti"I"A7~~ OI~ 1~ I.OFt i Uf~
cou~v~rY vr s1•. LUCI E '7'?'6985
This is my Ueclaration Domicile in the State o~ ~'lorida that I am f~ling this
day in sccordance and in conformity with SECTION 222.17, Florida Statutes.
I ~ ( W e ) , ' , ~b ~ - c~.:~~-~ ~ Irl
p ease print your name c e~r y
became a bona fide resident of the State of Florida on a- 19 ~v~
and I reside at a.~. l~ (~7~}'l1KS ~`r~r • ~
~r. the Ci ty of s-4- L~~~'~. ~
My ^~ailing address is: ~,-!~-M'e. S
i differen rom street a ress
My former legal residence was in the City of n~~(~-r1C~c~ ~
State af •
(No £urther statement is required. However, if you wish, you may insert any ~
p~rtinent facts such as sale of property or business or reZinquishment of ~
employment at former domicile, removal oF family to new domicile, purchase of
home, etc.)
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I FURTHER CERTIFY Z will comply with all requirements of a legal resident of
this State. I understand there ~.s a penalty for perjury;pe~jury is a Felony
and is punishable by incaration in the State Department of Corrections. _
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PRINT NAME SIGNA E
PRI?~T NA~1E SIGNATURE
Sworn to and subscribed before me this f~ %Y day of - , 19 0~ ~
, ROGER ~OITR~~.S.~.^ ERK IRCUIT CT. ~
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' Dep~~ ' ` erk
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RE~ORDING INFORMATION
>otary Pub2ic, State of '~'"~~rJ
- `sy Comr~ission expires: 'E5 19 Pi2:03
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