HomeMy WebLinkAbout0985 ~eclbrntion ut ~omtcit~
STATE OF FLORIDA ~ ~"15553
~ • COUNTY OF ST. LUCIE , • ~
This is my Dec~aration Domicile a~n the State of Flori.da that I am filing thi
day in accordance and in.conformixy with SCCTION 222,17; Florida Statutes.
I ~ (We), ~ I~tl D ElQ
p ease pr nt your name c ear y
became ~a bona fi~de resident of the State oF Florida on_ tT~L~ 19~~_
-and I reside at_ ~~j~~/ ~'%Ob.~.~'G{/O~a e~~c~,F
i n the C i t y o f ~U,~,7J `,7- ~ UGJ r ~L , ~ S~ 9, 3~~ .
My mailing address is:
i '~f eren rom street a dress
r
My former l.egal residence was in the City of L,l~FsT ~UFCJ~LD, oN/~_
State of. _ - D/V/V~'('~/~ ~"T
(No further statement is required. However, if you wish, you may insert any
pertinent facts sucr. as sale of property or business or relinquishment of
employment at former dom~cile, removal of family to new domicile, purchase of
home, etc.) . .
~
I FURTHER CERTIFY I will comply with all requirements of a legal resident of '
this State. I understand there is a penalty for perjury;perjury is a Felony ~
and~is punishabie by incaration in the State Department of Corrections.
V
~r'I T/~ D~ u/ ./3i~ ,t~ GEi~' ~ ,
~ PRINT NAME ~ SIGNATURE '
PRINT hAPSE • SIGNATURE
Sworn to a subscribed before me this J~~day of , 19
S DI' ERK CIRCUIT COURT "
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•ti r~'~G~EaF'- f-.
Deputy C er ~~;if~- cG
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~ ;f ~CORDING INFORMATZON
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f
yotaty Public, State of ~ :`~-,t-.;~.. _v ~
~ ~fy Commission expi.res: ~ ~?7~s Ji~
I
' ' '$8 FEB 24 P 2 :32
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' 576 ~~aG~ ~85
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