HomeMy WebLinkAbout0488 ~eclnrnf ~c~n af ~omicil~
STATE OF FLOR I DA 14 2 0 5 0 5
~ • COUNTY OF ST. LUCIE , ~ '
• This is my Declaration Domicile in th~ Stete of Florida that I am filing thi
day in accordance and in.conformity with SECTION 222.17; Florida Statutes.
I, (We), ~ , ~ - - ~ r?, -
p ease p ~ your n me c ear y
became a bona fide resident of the Stete of Florida on ~r~ - ~~_19 k~~
and I reside at a~o~ ~}„~,r~„ C~-~"
.
lfl C}1@ City Of ~~~.1 j} ~-~..c. c' _ ~,nr-~~i~ ~ti~i ~ _4 !
My mailing address is: ~ c ~
i f eren r~m s rce a ress
My former legal residence was in the City of~~~
Sta te of i;~ ,-,,Q,, ; .,-t .
(No further statement is required. However, if you wish, you may insert any ~
pertinent facts such as sele of property or b~siness or relinquishment of
employment at former domicile, removal of femily to new domicile, purchase oE
home, 'etc. ) .
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~ I FURTHiR CERTIFY I will com 1 with all re uiremen
p y q ts of a Iegal resident of
~ this State. I understand there is a penalty for perjury;perjury is a Felony
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~ and~is punishable by incaration in the State Department of Corrections.
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~ PRINT NAME ~ SIGNATURE ;
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~ ~RI~T NAME . ~
~ SIGNATURE
~ ' 1
~ ~worn to an~ subscribed before me this ~day of i~ , 19 ~f~ _ ~
~ DOi}~ ~?S DIh ; RK CIRCUIT COURT '
; BY - ~ _ ,Ci
~ - ~ ` ~
~ Deputy C er ~
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~ •
° RECORDING INFORMATION
~ ~otary Public, State of iO
20505
`1y Com;nission expires: ~ ;
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~ sao~ ~74 P~E 488
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