HomeMy WebLinkAbout0971 . • . ~ttl~r~tian ~~t ~m~ticite
STATE OF FLORI~A
• COUNTY OF ST. LUCIE 85~209 •
This ~a my Dec~aratio~ Oomic~le in the Stete of FloriBa ~haL I am fi~fng thi
day in accordence and in.con!`oi•mixy with S~CTYON 222.1~; F orida Statutes.
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p ease pr n• your nams c eer y
. became ~a~ bo~a fido reaiden! of the SteCe oP Floride on_ /~..3 i9_~
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•and I reside et l~ ~'d ,~'1Q.tJTr~ a ~
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in the Ci ty of_~~T, S~' r~ ,~'~L
i.r.~.s...~ . ..~.y..~.~~~
My mail~ng addresa ~s: ~ ~
eren rom s ree a ress ~U ~
My former le,gel residence aes i.n the City of,~f• / , ~
State of_,~~iG • ~
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- (No further statement is required. I~owever, if you wfsh, you may i.nsert a~y
perxinent faces such.as sa1~ oE property or business or relinquishment of
employment at former domicile, removal of family to new domicile, purchase of
home, etc.y •
I FURTNER CERTIFY I af1l comply wfth all requir~ments of e ~egal resident oi ,
this State. I understand ~here is a penalty for per3ury;perjury is a Felony
and~fs punishable by inceration in the State Department of Corrections.
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j PRINT NAME ~ ~ IGNATURE
PRINT NAME SIGNATURE
Sworn to and subscri~ed befoJce me this day of ~~c, 19
OUG~.AS~IX ~ CLE~j~~ij~ CZRL~tJIT~ COiTRT~
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eputy er ; _ +
4 ~ •'•.~A""M~, ~ { ~ • .
- • RCCORDING ZNFORMATION
?totary Public, Stete
o-~r~~i~ ~
yy Conynission expires: ~ • ~ 8582U9
. ~ ~ ~ ~g"t r~ov 12 P 2 :43
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(seal) ~ F~L: . ,
DO~~ut-~~
ST. l.i;t;~. . . ~ t . ;
gaoK 564 P~~E 9~0 -
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