HomeMy WebLinkAbout0969 ~ec~prn~inn ni ~uvmu~~r ,
STATE OT' FLORIDA ~1,2~ ~
~ COUNTY OF ST. LUCIE .
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This i~.s my Declaration Docaicile in the State of Floride that I am filing chi
day in accorda~ce and fn.conformity with SECTION 222.17, Florida Statutes.
I, (We) ~ /e7of' /u ~.~fL ?~LL-~ 2
p e~se pr nt your name c e~r y •
became ~ a bona fide residant of the Stete~ og Florfda on /~'1A y. i S 19 a'a'
and I reside at Z Z 2/ c• [L~A
,u~R~~6 c"y~C ~
in the City of ;
on~ ST ,(kQ;.~, j 3~S'~
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My mailing address is:
eren roca s reet a ress
My former legel residence vas in the City of ~-~,e~~ wc~~~
State of J C ~ •
(No further stateme~t is require~. However, iF you wish, you may i~sert any
pertinent facts such as sale of property oe business or re~inquishment of :
employr:~ent at former dowicile, removsl of family to new domicile, purchase af
home, etc.) •
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~ I FItRTNER CERTIF°Y I will comply with all requireme~ts oE a legal resident of~
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~ chis Staie. T understand there is e penalty for per~ury;perjury is a Felony
; and~is pvnishab~e by incaratio~ in the Siate Departmen~ of Corrections. ~
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PAIhT NAME ~ 5IGNATURE ~ ~
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PRI;~T NAHE • SIGNATURE
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Sworn to a~d subscri~ed before me this ~ day of , 19~ ~
Dq.114'~AS Dx~?~i~Y, ~ CIRCUIT COURT ~
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B~t- ~ : ~ > t= : . ;
Deputy er ..~:_~K~.~;,,,;R , ~
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4~~`~ • REC4RDINC INFORMATTON ~
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?~otary Public, State of ~ r ~ ~
yy CoT~:nissfon expiress . ~ ~1~'~
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. • ~ . ,f ` -1 P i :A2
(seal) .
~G:.l~.• '
ST. Lti[~ ~ -
BGG~ 5~ PAGE i3~
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