HomeMy WebLinkAbout0921 J '
UECLARA'ITON OF Dt~QCIIE 80J~~a~~
STATE OF FIARII~A
OOU~I'Y OF ST . LUCIE
~fiis is my D~eclaration of Daaaicile in the State o~ Florida that I am filing this
day in ~ccordance and in calforadty with Sectial 222.17, Florida Statvtes.
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ease pr t your mm~e c e~r y .
became a bona fide resi3ent of the State o£ Florida an (~c- C.In 2. 19~
amd I reside at ~~,1~ 2;~ tS-~-
in the City of C ~
My mailing address is:
erent street a ess
My forn~er legal residence was in the City of ___~Q~ 0~
S~ate~ of
(No further statemen~ is required. Now~ever, if yau wish, you may insert any
pertinent - facts such as sa1.e of property or business or relinquistunent af .
err~l.oyaoent at former do~cile, removal of fa~nily to new ri~icile, pvrchase of
hane, etc.) ~
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I FURTHCR fER'IZFY I will cvmply with all requirements of a legal resident of -
Chis State. I tnderstand there i.s a penalty for per~ury; per'tny is a Felvny
and is pu~ishable by incaraeratian in t;he State Depar4rnnt o~ Corrections .
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PRINf NAN~ IQVAT'lktE
PR I
THIS SPACE ~R REOORDING IlJ~RMATION
Swarn to and subscribed before me this
day. of . I9 ~ ~ $~~'J'~
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Notary Public, State of _
My Coaadssian expires:
Eseal)
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