HomeMy WebLinkAbout0987 ~ecl~~nti~n af ~crmicit~
STATE OF FLORIDA . ~~~~..~iS
~ • COUNTY OF ST. LUCIE , • '
This i~s my Dec~.aration Domicile in the State o~ Florida thaC Z am filing thi
day in accordance and in.conformixy wfth SECTION 222.27; Flor~da Statutes.
I~(W~)~ /1/~~~ lf f=. ~OG~G. "
p ease print your name c ear y
became ~ a bona ~3.de resident of ~he State of Flor~da on_~',Q,,c~ f~ 19~
~and I reside at ~2 1~ lo L. ~O w t~ .
~ in the Ci ty of ~c~ ~ T S r~ G- ~ cr!
My mailing address ~s:
i ~f eren rom street address
My former Iegal residence was in the Ci~y of ~ I~05 ~v~.
State of ~ ~ H I Cz A .
(No further statement is required. However, if you wish, you may insert any
pertinent facts such.as sale of property or business or re~.inqui.shment of
empZoyment a~ Former doma.cile, removal of Family to new domicile, purchase of
home, etc.) .
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I FURTHER CERTIFY I will comply with all requirements of a legal resident of ~
this State. I understand there is a penalty £or perjury;perjury is a Felony
and~is punishable by incaration in the State Department of Co~rections.
,v ~ ~ r- o a k L?z~~..
PRZNT NAME ~ SI6NATURE ^
~ PRINT NAME • SIGNATURE
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I Sworn to an subscribed before me this _~~day o , 19~_ -
I DO S D~~iO ~CIRCUIT COURT~~_:,: ~h--~~...;,;
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~ Deput C erk , - '~1,-
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`~J.~ ~ y~• :~`~~t R~CORDING INFORMATION
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?Iotary Public, State of ~ ~ ~ `
~ r*r+T . ,-~,f.~- ~ s r-
~ly Commission expires; ~ y~.
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