HomeMy WebLinkAbout0925 • • ~ " ;
~ecl~rnli~n af ~omuc~I~ -30-,- yi g
STATE OF FL.ORIDA $64zJU ' ~
• COUNTY OF ST. LUCIE ' V ~
This ~s my Declaration Domicil.e in the State of Floxida that I am fili~g thi i
day in accordance and in.conformixy with SECTYON 222.17; Flor~.da Statutes.
I ~ t (~@ ~ ~ ~~'o L:/ . ~r ~r.~ J J/L . 7- /C ~ T /r' ~ • /-~'/~/~C?
p ease pr n~~your name c ear y
. became ~ a bona fide res~,dent of the State of Florida on ~ 19
~and I resxde at 2. yyl .S t' •~AsGA/ i9v~,-,
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~n the ci ty o~ ~ f T. L~~,~r F/~,-,:0,~ 3yy f
My maili~ng address ~s:
i ~f ~ren rom street a dress
My former legal residence was i.n the City of /~/~v.,~
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State of ~~c.- . _
(No further statement ~s required. However, iE you wish, you may insert any
pertinent facts sucl~. as sale oF property or business or relinquishment of
employment at former domicile, removal of f~mily to new domicile, purchase of
home, etc.~ .
o , stf t.~ ti, c9 l o~, .,c
/1 / L ~ /1 / / dl ~it'J • y -
I FURTHER CERTIFY I will comply with all requirements of a iegai resident o~ '
t~is State. I understand there is a penalty for perjury;perjury is a Felony
and~is punishable by incaration in the State Department of Corrections.
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' PRINT NAP1E SIGNATURE
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; PRINT NAME SI NATURE
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~ Sworn to and subscribed before me this day oE , 19
~ DOUGLAS DI~ON~ CLERK CZRCU~T COURT
~ BY
Deputy C er
~ R~CORD~NG INFORMATIOH
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f ~
~ ?lotary Public, State of /y~-~/~~s~v'~~ ~~~U
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yy Commission expires: •
• ~~:*~c.:-Hr t~. ~-~T,: pE~ 18 I~1 ~2?
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(seal~ FIL~t~ ~h~ ER~
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~ ; - . , - ~ - ao~x 5fi8 P.,~~ 925
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