HomeMy WebLinkAbout0966 ~ ~ ~ ` ~eclurntinn uf ~omirtl~ . ~ ~
s1~nr~ vr• rLOii i nn ~
COUNTY OC S1'. LUCIE ~18~~rf
This is my Declaration Domici~e in the StAC~ oE Florida that I am ~ilxng this
day in accordance and in.conformity with SCCTION 222.17, Cloxida Statutes.
S. o se, 1(
i;c~>, Ma,~.,
please prx~t your name clear y
became a bona fide residen,t of the State of Florida on , 19 ~
and I reside at ~~10 o S~, 0~,,~.ar Dr.__ ~ ea~.1~ ~'Y~~~~
in the City of Fy`. P i~r c~
My mailing address is:
; _ i differen rom street 9 ress
,
~ My former legal residence was in the City of C~ ~1~.~v s.~ ~ I~e,
! State of Mcz~c~ q~,c~ •
{Nc~ furth~x st~~~men~ ~s ~~~ua.~ed, 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 o~ fami.ly to new dom3.cile, purchase of
~ home, etc.)
~
~
I FURTHER CERTIFY I will comply with all requirements of a legal resident of
this Stat~. Z understand there is a penalty for pexjury;perjury is a Felony
; and is punishable by incaratiofl in the State Department of Correcti~ns.
t
:
~
~ n
~ a^r v S, 1'C o s~. ( ~ ~
PRINT NAME SIGNATUR
PRINT NAME • SIGNATURE .
' Sworn~~~to~~and s~tb~cribed before me this ~day of , 19
~ b ?
ROGE~t~:~?OITRAS; o:~ ..y ~ CIRCUIT CT. -
,
By ~ -
. ~ =
. ~ ~ e~;u G erk
~ -
, : . : . .
~ ' y, . ~ ~ ,
RE~ORDZNG INFORMATION
:>otary Public~, State of ~ $~p -g pq0 ~16
Hy Commissxon expires:
- Fi~i_:: '
ROGEt; 'r-~_ .r
- ST. LU~l: ; _ _ . _ .
(seal) rr80~~ ;
_
"
i ~
~
soox 513 PacE 95'9 .
- ~ - - , _ _ _ .
~ - -