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STATE OF FLOR I DA i 0 2 0 51 I
COUNTY OF ST. LUCYE
This is my Declaration Oomicile ih the State of Florida that I am filing thi
day in accordance end in.conformiLy vith SECTION 222.17; Florida Statutes.
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I, (~le), ? ^ ~ - ( < .
, p ease pr n your name c ear y
became ~a bona fide resident of the State ~of Florida on~:, ;r ig~,
~a~d I reside at " " < - n ~~;.~r j ~
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in the Cit of ' - ~
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My mailing address is:
eren rom s ree a ress
My former legal residence was in the City of 1~
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State of ~ .
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(No further stateme~t is required. However, if you wish, you may i~sert any
pertinent facts such as sale of property or business oc relinquishment of
employment at former domicile, removal of family to new domicile, purchase of
home, ~etc. ) ~ ,
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I FURTHER CERTIFY I will cosnply with all requirements of a legel resident ot
this State. I understand there is a penalty for perjury;per,jury is a Felo~y
~ and~is punishable by incaration in the State Department of Corrections.
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~ PRINT NAM~ ~ SIGNATURE
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E PRINT NAME • SIGNATURE .
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~ Sworn t and subscribed before me this `
~ ___~~day of , 19~
p G ON CLERK CIxCUZT COURT i
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RECORDING INFORMATION
~ ?totary Public, State of
` ~y Corqmission expires: . ~ - 102 ~ 511,
5~0 JAN 22 P_, ~
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Rec Fee S~CG I)Ot;GLAS UIXON
: Add Fee S St. Lucie Cuunty
` l~rc Tax S Clerk uf Circuit '
{ . ~r,' ~ ' ~'f Int Tax 5 ~y ~
s ^ Deputy Clcrk
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~ ~ BOOK 67~ PACE 4a~
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