HomeMy WebLinkAbout0970 ~1lirtlAfA~~c~n `~t Lwuu«a ~ir
STATE OF FLORIDA
COUNTY OF ST. LUCIE r~I12.'Z~
This is my Declaracion Domicile in the Stete of Florida that I am filing thi
day in accordance and in.conformity vith SECrION 222.1~, Florida Statutes.
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I, Ne ~ - ~1~-a Y~ C' ^TYc~c' I,-1
" '(please pri~t your name c r y •
became ~a bona fide resident oE the State~ of Florida on _+~~„~,~-~19~_
-and I reside at ~7 t= %y~~~ ~r; i~~
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in the Ci ty of ` .
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My mailing address is;~r~, ~ S~>,~~ ~r ~ .
(if dff eren rom s ree e ress
My f ormer legel rssidence vas i~ the City of_ ~
Sts[e Of ~~~Yn~C~~~~""
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(No further statement is required. However, if you wish, you may insert any
pertinent facts such as sele of property or business oc r~lfnQuishment of
employr~ent at fatmes domicile, removal of family to new domicile, purchase of
home, etc.) .
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I FURTHER CERTIFY Y will comply with all requirements o~ a legal resident ot
this State. I understand there is a pena~ty for perjury;perjury is a Felony ~
and is punishable by incaration in the State Department of Corrections.
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PRINT NAME ~ ~IGNATURE ~ ~
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PRI'~T NAME'f • SIGNATURE ~
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Sworn to a~d ~ubecri~ed before me this ~'r~_day of , 19
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DQUGL~t$ DIXOt!l,, CI.E~-,CIB~UIT ~POi~T ~
By - _ ~ . - ~ -l'` • , ~
eputy er ~ ~
RECORDING INFORMATION
~otary Public, State ot -
tiy Corry~nission expires: ~ _ ~U~.228 i'
• ~ ~s ' i P 1:42
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(seal) ~
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S T. l. t. K
EC~~ 59e7 ?^~rf J7L~
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