HomeMy WebLinkAbout0492 ~ectarnt~~n ~it ~om~c~~e
STATE OF FLORIDA 1020508
~ • COUNTY OF ST. LUCIE , ' ~
This is my Declaration Domicile in the State of Florida that I am filing thi
day in accordance and in.conformixy with SECTION 222.17, Florida Statutes.
I, (We), L_FR~~ ~~2 ~ ~ j~} n' ly PI 22~~
p eese pr nt your name c ear y
became ~ a bona f ide resident of the State ~of Florida o~ C, ~ 1? 19
~and I reside at ~-1 Q 2 S!~l/ ~tn~t7TFI~'f~ ~-y` ~ f~ l7`~ 3~f )r~3
in the City of P( r___L-v~G 1~~= ,
My mailing address is: a- ( Q 2 S w r? r ty ~F~~~~ ~ ti~~ , 3 r f~~
i '~f eren rom s reet a ress
My former legal residence was in the City of ~'I~tf-~---'~~-~l''~ S7~[~~ /.5..
S t a t e o f ~(.U ~/c~ .
(No further statement is required. However, if you wish, you may insert any
pertinent facts sucl~. as sale of property or business oc relinquishment oE
employment at former domi~ile, removal of family to new domicile, purchase of
home, ~etc. ) •
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~ I FURTHER CERTIFY I vill comply with all requirements of a legel resident of
~4 this State. I undersiand there is a penalty for pErjury;perjury is a Felony
~ and~is punishable by incaration in the State Department of Corrections.
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PRINT NAME ~ SIGNATURE
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~ PRINT NAME • SIGNATURE
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Sworn to and subscribed before me this ~~day of z~-~, , 19'a~~-~.
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~ - DbUGLAS D N, C~LERK .~~~UZ.Tt .~'~JRT , ~
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$ By ~ - t ~ ~~i. C t~ • 1` l i:
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~ Deputy C er .
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` ` ~ RECORDING INFORMATION
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~ ?lotary Public, State of `.r~" P' ~ i ~
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yy Cor~mission expires: ~ ~ g/~
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(seai) ~ J~ 1020508
Rec Fee 5._l~___---- U()UtiLAS UIXON ,
f Add Fee S_ St. Lucie County
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