HomeMy WebLinkAbout0950 . . ~~ctnrr~t~an aI ~o~aicilt ~
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STATE OF FLORIDA 86~~"~s ~ x~"' .
. • couN~r oF sT. Lucig , ~ . •
This is my Oec~aratiott Oom~cile in the SEata of FloriBa het I am fi2f~g thi ~s
day in accordance a~d 3n.aonfo~ixy vith SECrxON 22Z.t7; F~arida Statutes. -
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, eaee r n•your name c ear y -
. became ~ a bona ~ids resident ai' the State ~ af Flori.d~ on,,,_~,,: _1,~;
__,~19_ ~f. 7
•and I reside a!~ ?~~.:.,~,~;n,~,az,,~„~p 1P' .
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~ ~ • ~ I 18 ~ i {r y ~ a ~ ~ ' ~iw+iw~w~~ i~..~ w~~ . .
My mailing address ~s i . ' , .x'~ ~ ~
eren o s~rs 8 resa
My former lsgal reaidence vas itt ths City oF e_,
State of ~ / . ~ . ~
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(No furthe~ statement ia requfred. i~oaever, i~ you wfsh, you may insert Any _
pertinent facts such.es sale of propsrty or busfnesa or relinquishment o£
employment at ~orm~r doa~~cile, remavax of family to rew domici~le~ purchase oE
home, etc.~ _ ~ ~ •
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I FURTHER CERTIFY I will comply trith all requ~rements of a le~el resident o~- :
ehis State. I understard there is e penalty for perfury;per3ury is a Felony
and'is punishable byr inceretion in the State Depertment of Correctfons.
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PRTNT NAME ~ SYG ~TURE ~
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PRINT NAME SIGNATUItE .
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; S~orn _to and subscribed begore m~ this ~~~~dey of , i9~
; DOUG D2X4 CLERK G"~RCUIT C~tJRT .
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~ U• < RECORDING NFORMATION
?totary Public, State o~ - " i~ ~ . _ - . ~ .
~y Co,n~af s s f on expires s~' •••~"~.~~s~.: ; 866f~?`S -
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. ` . ' '~6 .~N~1-~t A~1.45
( seal) , . !L DASN ftEG~RDED
~ S . tUC1E CoUN~Y~~LK
800i(~ (O PAGE
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