HomeMy WebLinkAbout0965 . . ~ . ~~tt~tratian af ~o~eti~cilt
STATE OF FLOR IDA ~3OSU1.
COUNTY OF ST. LUCIE , '
Th~s is my Dealexati~or Daaicile in the St~t~e of Floxfda hat I am fi.ling thi .
day in ~ccordanca and ~n.aonfo~mity vith SEC'1'ION 222.17~; F~orida Statutes.
(We~, . uSS
p ease pr ni~your nams c eer y
.baceme~a bona fida resident f the State of Flarida o~ 19
•and I reside aC o2 ~/.d.~/~i9 o~J ~!/'~4
~in the City of ~ /
My mailing address is: - ~
eren rom s ree a ress
My former ega2 residenc was in tha City of
Sta?te of Nk`C~Cu ~ . ~
(No further stetement is required. However, if you wish, you may f"~sert a~y
pertiflent facts such.as sale of property or business or relinquishment of -
employment et former domicile, removal of family to new domicile, purchase of
home, etc.) ~ . . . .
I FURTHER CERTIFY I will comply wfth all requirea~ents of a legel resident oi
this State. I understand there is a penalty for perjury;per3ury is a Felony
a~d'is punishable by incaratfon fn the State Dep ent of Corr ctions.
fr'~ ' Gl ~ S •
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PRINT NAME SIGNATURE
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~ PRINT NAME ~ SIGNATURE
Sworn to end subscri#~e efore me this I~dBy of , i9 $^l
C S DI~O ~ CUIT COURT
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@pUt sA
v , } ~is .
~ ~ . ~vs`- RECORDING INFORMATION
~ yotary Public, Stat _
yy Gon~mission expiress • ~ 83OSO1
" , • t . ~ '87 JUN 16 P 1 :10 ~
(seal) ~ FILE+'_. ' ;'i1RDE
DOUGI,~':~ ~f }:ON CLERK
ST. L•UCIE COUtiTY. FL.
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