HomeMy WebLinkAbout0928 . , ~7~{?~f/~N~~~~~~
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S~ATE OF FLORIDA ~ ~ ~
~ 1 ~OUNTY OF ST. LUCIE , • ~~~~4 . -
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This i~s my Declaration Domicile in ~he State of Flori,da ~haC I am fi.ling this
day in accordance and in.cot~tofm~xy with SECTION 222.17; F orida Statutes.
~(We), : ~ • lo!/ -
_ p ease px n your name c ear y. ~
.became~a bona fide resident of the State of Florida on ~2~- 19
•and x reside at ~S e
~ in the Ci ty of . / E
My mail~ng address is: ' i4 d~
~ i f eren m s ree a ress
My former legal residence was in the City of_,~'f,~}~D
State of _ .
(No further statement is tequired. However, if you wish, you may insert any
pertinent facts such,as sele of property or busiress or relinquishment of
employment at fqrmer domi.cile, removal of ~amily to new domic~le, purchase of
home, etc.) ~ ' .
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I Ft1RTHER CERTIFY I wi2l compl.y with all requirements of a legal resident of
this State. I understand there is a penalty for per3u~y;perjury is a Felony
and~is pun~shabZe by incaration in Lhe State Department of Corrections.
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PRINT f3AME ~ ~ S NA2URE
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~'RINT NAME SIGNATURE .
Sworn to and ~ubscribed before me this ~1day af , 19~~
DOUGLAS DIXON, CLERK CIRCUIT C4URT
By_,~,.C- ~
~~eputy C erI~c-- ~
~ RECORDING INFORMATION
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. _ . ~ 825834-
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' ~ , tr ~ . 'g7 MAY 22 P 1.09 ~
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' ' ~ r.:IRDED
. ,,~~ge~.~}._~~..~>~~`:~~ FILED ~Ni-
~ -L-..:.,;,~t= - ~UGLA5 Gl~.`?x~CLERK
' j ~ , S'f. LUCIE COUN ~ Y. Fl..
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