HomeMy WebLinkAbout0529 ~gt~t~rnti~n nf ~8omicile
STATE OF FLORIDA 10205ze
• COUNTY OF ST. LUCIE ~
~
This is my Declaration Domicile in the State of Florida that I am filing thi
day in accordance and in.conformiiy with SECTION 222.17; Florfda Statutes.
~ twe ~R ~~D r9~' R/ee¢ o`_"f~ 1
p eese pr nt your name c eer y
became~a bona fide resident of the SteLe~of Florida on /~_19_~
~and I reside at ~
in the City of L-- ` ~ r
My mailing address is: ~
eren rom s ree a ress ;
My former le al residence was in the City of ~CJ o c~ r-'~ ~
State of , •
.
(No further statement is required. However, if you wish, you may i~sert any
pertinent facts such as sale of property or buainess or relinquishment of
employment at former domfcile~ removal of family to new domicile, purchase of
home, 'etc. ) ~
;
' ~
I~ ~
. i
!
~
;
I FURTHER CERTIFY I will comply with all requirements of a legal resident of ~
~ this 5tate. I understand tbere is a penalty £or perjury;perjury is a Felony ~
~ and~is punishable by incaration in the State Department of Corrections. '
;
~ J~a ~ ~ ~CJ ~ ~ ~
~ PRINT NAME ~ SI6NATURE
~
~ ~
~ff~ ~3 ~ ~ t~ ~-1 ~'c t~ o ~-L~ ~'~~~u._., ~C - C7G ti~.--~'~~
t
` PRINT NAPiE • SIGNATURE
~
~
~ Sworn t and subscribed before me this ~day o , i9
~ - ~DIRO C CUIT COURT
y ~
~ Deputy C e `
~
~ ~ RECORDING INFORMATION
~ ?~otary Public, State of '
~!y Comr~ission expires: • ~ '90 JAN 22 P? ~
- ~
fi~., ~
~ ~ CQi.i~~ : f Lt;
' - +
(seal) '
Rec Fee ~_5~---~4tIGLA3 DIXON •~142 0 S 2 e
~ S. . . . _ C'ounty
's Add'reeR_ ,
' Doc Tnx S ~rcuit Court
~ Int Tax i - By~
? Deputy C1erk '
Total i ~ .
. . . BooK~?4 ~E 529
e~.~i:l:, s~_~~~~.~~3 . ~ Vti ~..v.v;::%'.