HomeMy WebLinkAbout0998 . ~ ~ . ~ttl~r~tinn ai ~~iciit ~ •
STATB OF E'tORxOA .
COUNTY OF ST. LUCIE •
This is my Oeclaration Domicil.e in ~he Stiate o~ Floride hat I am filing chi
dey in accord~nce and in.confoi~aizy vilh SECfiION 222.I~; F~orida Stetutes.
I, Ct~e), ~ he n a u~t h.~; t 2a.t i r k
. p ease pr n•your neme c ear y
.
. beceme ~ a bona f~de residert oF the Stete of Flor~de on~( __„_19
~_~b
•end I reside et_ t07e~~ S• ~ 1 ~ ~t~ ~ ~.8q -
, ..o.~
in the City o~ en eh ~ti ' a 3 5
My mailing ~ddress s: ~ ~
eren rom s ree a ress
My former la$al r~siderce vas in tihe Ci~y of_ t' ei ~
~ Z ~s'
S L e t@ O f 1'1? e.1~? i~. a v~ •
~~i~Y ¦ ¦ ~~I~~~~~Y~~ ¦ .
(No further statemenL is required. yowever, iF you wish, you may i.asert ~ny
- pertinent facta euch.as sale of grnperty or busit~ess or relinquishment~of .
employment at forcper domicile, remova! of family ~o new domicile, purchase oE
home, etc.~ ~ ~ .
- - - - - ,
I FURTHER CERTIFY I rrill comply with aii requirements of a 2ega1 resident o~
this State. I understand there is e penalty for pexjury;perjury is a Felony
and~is punishable by in+~aratfon fn the SLat epartment~of Corrections.
.
~~e nhen At~rkq _
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PRINT NAME ~ ~ SI NATURE
_`~ut ~ d~N, ~a t i r k0. ~
_
PRINT NAME SIGNATU E .
Sworn to and ~ubscribed befor R>t~is day of ~ ,~9 ~1
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UG D~ ON, R~ _
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epu~y er • - ~ - ~
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. `'~`Y~ ~ ~ ~ ~ ~ RECORDxNG INFORMATION
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~totary ~Pub].ic, State of - ~
yy Conyrission expires= • ~ •
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