HomeMy WebLinkAbout0489 ~ ~C~.°LI~~T~t7~OV OF ~~K ~+2 i t F-.
STAT~ OF ~'LORIDA 1~2OS06
~ co~t;;T~~ eF sT. LUCIE . ~
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:~:is is ny Declaration Domlc~Ie in the State of filori~e thAt I 8m filing t
~~y in 3ccordance and in.confoYwity ~ith SECTxON 222.17; F2orida Statutes.
',(~tn~f L.D~IS ~ f~ T1l y'~. D~ 7SC1~
p ease pr n~your name c ear y
~~eca:~e ~ bo:~a fida resident of the S~ate o~ Florida on It ~g ~
~~:nd ? reside at ~}2$5 Nh/ $AL~ i
ic,~ ,$i,QEEi
i:, th~ City of f~0~ sT ~Cr~"• 3~f~~
t~'y :~ai2ing address is:
i t~tf eren rora street uddress
~;y former legal residerce was in the City oF F'T. ~t~,
St~te of ~~'DA •
(";o :urther statement is required. However, if you i~~ish, you may in~ert any
~ertinent fa~ts such as sale of property or business or relinquishment of
e~:ploy,^~ent at fortaer domicf le, removal of f~mily to new donicile, purchase of
}~o~:A, etc. ~ • .
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: F~RiHER CERTIFY X~till comp].y with eII requirements of a legnl resfdent
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:his St~te. I understand there is a penalty For perjury;perjur~ is a Pelony ~
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- ab b inr.eration in the State De artment of Correcti
~~d~is unish Ie ons.
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c: I N i I~'~`i~ NATUR
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P:.ZtiT tiA~,E SIGNATUtt~
St; ~rn to and subscribed -bofara me this /~7~ day oF c~/~~l(/41Q~ 1R
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DOL'GLAS DI~ON ~ CLEItK CIRCUIT COURT
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RCCOROING INF'ORMATION
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~ ~90 ,1~.~J 21 G'
• ~ NOTARY PUBLiC. S~ATE OF FLORiDA
. ` k . MT CQMMISSION EXPiRES: FEB. 9. 149T~ Q j~
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