HomeMy WebLinkAbout0966 . . ~e~~ti~n ai ~oaticit~ ~r•
STATE OF FLORIDA 83QSOx,
COUNTY OF ST. LUCIE , •
This is my Oec~~ratio~ Dom~cile in the S~ate o~ Flor~da that I am filing thi
day f~ accordance end i~.c~otifoicmi~y wizh SECTION 222.l~; Florida Statutes.
I ~ ~ ~ iJ d N J , ~ ~1~ ~o?'~/ f",, ~ ,,2,t~~'
~
p ea~e pr n~ y.our name c ear y `
.became~a bona fide res~dent a~ the State~of Flor a on lO t- ~9
•and I resfde et ~~.tf~~'.4L ~i¢'7'7t7 7~~'~e~A-~~'~
~ in ths Cf ty of ea v~~ ' i.D,C~.-
My mail~.rig addr~ss is: o~~~..v ~~•r-,~-~J~'~F 1~L. 3 3¢,~S
, eren rom s reet '8~a"ressj`"'~~
My f ormer Iegal re idence wa in Lhe Ci ty of_~,~r"iCJD/~i~~2~
~ State of . ~
. (No further statement is requfred. However, if you wish, you may insert any
. pertinent facts such.as sele of property or busfness or relinquishment of
employment a~ former domici~e, removal o£ £amily to new domicile, purchase of
home, etc.) ~ . .
:~_r_____
I FURTHER CERTIFY I will comply with all requirements of a legal resident oi
this State. I understand there fs a penalty for perjury;perjury is a Felony
and~fs punishable by incaratian in the State Department of Corre fons.
. ~o~J ~Yr~,~~ ~
PRINT NAME ~ Sx ATURE
. -~k'~ ~ ~
PRINT NAME ~ S~GNATURE
?
Sworn to and subscri~ed before me this -~,~~~`~day of , 19 ~ 7
DOU ZXO CLERK OURT
BY JQ:.,,.... . fol, ,
P er .a~
~ • W ~ .
~ tY~ ~
RECORDING INFURMATI~N
, ?totary ~ublic, St~te of 3~ ~ 834502
~ :~y ~on~mission expfres: •
' ~ ~ ~ '87 •~Al~ 16 P 1 :10 c~
.
4 • . . ` ~ ~ROEO
(seal) FILE~ ;
~ ST GUrC(E CCUN Y. FL~
i
'I
~ ~
I ~
.
~ ~
6t~ ~I~ PACE ~
. .
- ,_...Y..~_._:_~~__~. _ _
-