HomeMy WebLinkAbout0944 ~~ttl~r~ti~n aI ~oraicitt
STATE OF FLOR x0A 866s"r~ -
• COUNTY OF ST. LUCIL' . ' '
This is my OsclaraLian 1?aaicila in ths State of ~lori~a het I em filf~g thi
day ~n accordanca and ip .cotntoi'a~ity vith S~CTION Z 2.17, P'~oride Stetutes.
. /Q ,
I' C~~i,'^ \l ~ 1'~./ ~ G - ~O ~ I ~ W ~ ~ ~ w..~.i ~~~w~
p oaes pr r•your ~ams c ear y
. became ~ a bona ~~ds rasida~rt o~ the Ststo ~ o~ FZor~d~ or __~9-,y
3__
•end I reside at 4
i.~.s~J,f.~.~._..~~__:..~....__._~._,_.,~.
` i n t h e c i t y o~~,p„ t,~.~.,s.;:.~..,_. ..__..3~.,~.~_..~,._._
My maflfng nddress ias ~
, e en aa ree e resa
My former lsgel residerce ras ~n the City of_.,,_,,,~C/~~~`
S t a t e of_ _ C~
~.!,~,:~r- •
(No further steteaaenti. is requfred. I~owever, if you wish, you may insert any
pertinent facts such.as sele o~ property or busiaesa or relinquishment of
~ employment at former damicil~o, reaaoval of family to new domicile, purch~se of
home, etc.~ ~ •
_
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I FURTHER CEATIFY I aill comply with all requirements of a legal resident o2
` this State. I understand there is a enalt for er ur ~ er ur is a Feion
_ P Y P~ Y~P ~ Y Y
and~is punishable by inceretion in the Sta~e Departaaent of C~orrections.
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' ~ o A ~v ~ E l~f o ? i9 w s K r ~ - ~ ~ ~ . '
~.iar~~~~ u -
~ PRINT NAME ~ SIG~NATURE
s
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i PRINT NAME SIGNATURE .
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r
~ S~orn to and subscri~d before me ~thie ~
day of G+~`"`-' , i9
f_
~ DOUGLAS D , CLE ~ ~T
G ~
~ By ` ' <<f,~'y
~ eputy er ~ :.g
' . .
` G~s a .
~o RECORDING xNFORMATION
yotary Public, SLate oE °~~n ~S"" o?~ •
yy Con~mission expiress ~ • ~ • . 86s672 -
. ~ • ~ y . . W ~ ~
(seal) ~ : i EQ !iA RcCORDED '
(,A OlXpti CLERK
. LUCI~ COUNtY. FL.
~ g~oK 570~ PA~F 944
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