HomeMy WebLinkAbout0497 ~ec~~rnt~~n at ~vomu~~p
STATE OF FLOR IDA 10 2 0 5 i 2
COUNTY OF ST. LUCIE '
This is my DeclBration Domicile in the State of Florida that I am filing thi
day in accordance and in.conformiLy with SECTION 222.17; Florida Statutes.
ti ~
I, (We), ~ c~? ~ c=~ I. u
p ease pr nt your name c ear y
became~a bona fide resident of the State~o~ Floride on J ~c~ 19
- z:
~and I reside at ~ ~ I ~ ~
,
in the City of `~f ~1~• <
J ~
My mailing address is:
f eren rom s reet a ress
My f ormer legel residence vas in the City of_ ~ c il~~~
State of ~~i~-~,.~ - ~s
, • .
(No further statement is required. ~owever~ if you wish, you may insert any
pertinent facts such.as sale of property or buainess or re~.inquishment of
employment at former domfcile, removal of family to new domicile, purchase a~
home, 'etc. ) .
f ~
~
i
'I I FURTHER CERTIFY I will comply wfth all requirements of a legel resident of
~ this State. I understand there is a penalty for perjury;perjury is a Felony
~ and~is punishable by incaration in the State Depa-tment o~ Corrections.
~ ) ; t' j ~ F t ~ { L' ~ N ' - ~'~1lrJ c'
~ PRINT NAME ~ SI6 RE
~ 1 j ~ ~
~ ~'tnS ? F ~ ~ 1
~i?~ ~ ' / ' Q
~ -
~ PRINT NAME • SIGNATURE .
Sworn to and subscribed before me this 1~6 day of ~~~,~~-C~•~~~~.-~- , 19 1~
~ -
~ D;f'1UGLA DI ' , ~ CIACUI,T • COURT . '
~ By-- ~ ~G~~~ .
~ Deputy C er ~ ,
~ . ,
~ ' RECORDING INFORMATTON
~ _
~ ?Iotary Public, State of ~ ~
- 1420512
~1y Cor~mission expfres:____ • . .
, . .5+0 JA~~ 22 P ~ ~1~
. 8
; noua~ ~ . . : . : ,
( s e a 1) p,~c Fee f--s"""'' S~ Lnde Co~ f~ • ~ r, ; ~ G ti i
; Add F~s i~~'~' a~f,~~{t Ca~ . t~ i
~ poc Tsx i ~ >
= Int Tax i-~'~"~ Deputy Clerlc I
~ , '
~ Total s , il
a
e' .
~ ~I
I
' I
. . ~oa~ 674 PAGE 49? '
~
~i ,.r.~ :i~?~s ~ -w ~~.i~' °
~