HomeMy WebLinkAbout0984 . ~9e~I~rnti~n uf ~lomicile
STATE OF ~'LORIDA ~~SS i~
~ • COUNTY 0~ ST. LUCIE , ' ~ '
This is my Dec~aration Dom~.cil.e in the State of Florida that I am filing thi
day in accordance and in.conformity with SECTION 222.17, Florida Statutes.
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I, (We), ~s~ D d I ~d ~
p ease print your name c ear y
became ~ a bona £ide resident of the State of Florida on ~1 , 19~,J~~.L~~
~and I reside at l~ ~ .S d~ l~ t/
in the Ci ty of ~OC7~ ~~J Gi ~l~ .
My mailing address is:
i ~f eren rom streeC a dress
r-
My former legal residence was in the City of J/~G v,v l~
State of /t ~ G- , •
(No further statemenC is required. However, if you wish, you may insert a~y
perCinent facts such.as sale of property or business oz relinquishment of
employment at former domicile, removal of family to new domicile, purchase of
home, e~c.) •
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I FURTHER CERTIF~ I will comply with all requirements of a Iegal resident of
this State. I understand there is a penalty for perjury;perjury is a Felony
and~is pun5.shable by incaration in the State Department of Corrections.
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PRINT NAhiE ~ SZGNATURE
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i PRIi~T NAi~fE • SIGN TURE
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! Sworn to an subscribed before me this day of , 19
,
j DOU S DZXO , CIRCUIT COUR~~
~ By'~~ • .I' _
~ Deput C er : . ~ . '
. . _ .
~ RECORDING INFORMATION ~
I ~lotary Public, State of ~
~ ~ 8'7~~52
~1y Commission expires: •
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, '88 FEB 24 P 2 ~32
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