HomeMy WebLinkAbout0994 ~t3ect~rn~ian s~t Ziaamui~g ~ ,
'7'76986
5"i'A'1'~: Ul~ I~ 1.OR IDA
COUN"1'Y Ul~ S1'. LUCIC
This is my Declaration Domicile in the State of Florida that I am filing this
day in accordance and in conformity with SECTION 222.17, Florida Statutes.
I,(We), ~
p eas print youL name c ear y
became a bo~a fide r~sident of the State of Floric~a on p 19 6
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and 1 reside at
in the Ci ty of a/l~-'
My mailing address is:
if differc~nt rom street a dress
My former le al residence wa$ in the City of ~~~~6~/~~
State of < N~ ~ •
(No further statement is required. However, if you wish, you may insert any
pertinent facts such as sale of property or business or relinquishment of
employment at former domicile, removal of family to new domicile, purchase of
h~me, etc.)
I FURTNER CERTIFY I will comply with all requirements of a legal resident of
this State. I understand there is a pen~Ity for perjury;perjury is a Felony
and is punishable by incaration in the State Depart:nent of Corrections.
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PRINT NAME SIGNATURE
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~ PRI~T ?~AHE SIGNATURE
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Sworn to• srsd subscribed before me this _J~day of_ - c , 19
POIT~tAS, CLIItK IRCUIT CT. ~
By 'X
D erk
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~ RECORDING IIvFORMATION
>otary Pu~I'ic, State of
- `fy Commission expires:
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~ '~5 A~, 19 P12:03
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