HomeMy WebLinkAbout0495 ~rtlnmtinn t~f ~rnnicil~
STATE OF FLOFIDA ~ O G O S~ O
COUNTY OF ST. LUCIE
This is my Declaration Damicile in the State of Florida that i am filing thi
day in accordanc~ and in.conformiiy vith SECTION 222.17, Florida Statutes. ,
We ~ T , ' z ~ /E~ ` ~ ' I
If~ ~t /Nc~r. ~ , ' ~
p ease pr nt your name c ear y j
became a bona f ide resident of the State of Florida on 19 1'
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~and I reside at ~>i ~ r:1 ~ ~ iy~~` ~ ; ~ -
in the City of ~2 ~ ~;c. ~ ? ~
My mailing address is:
d~f eren rom s reeL a ress
My former legal resfdence ~oas in the City of ~-`~^'`T~~ ~h'~°~
State of `i! y~ •
(No further statement is required. HoWever, if you wish, you may insert any
pertinent facts suct~. as sale of property or business or re~inquishment of
employment at former domicile, removal of family to new domicile, purchase of
home, etc.) ~
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! I FURTHER CE~tTIFY I will comply with eil requirements of a legal resident of
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j this State. I understand there is a penalty for perjury;perjury is a Felo~y
~ and is punishable by incaraLion in the State Department of Corrections.
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~ PRIh'T hAME _ ~ SIG AT~JItE . _
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~ PR?!~T hAME • SIGNATURE
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` Sworn to~and subscribed before me this day of ~,;..~.`~~•-t--~, I9
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¢ , J~~AS DI~iO CLER~ C~RCUIT COURT
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~ Y Deputy C er -
~ ~ ~ R~CORDING INFORMATION
~ ?totar Public State of `
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