HomeMy WebLinkAbout0603 E~"
~A,,.~ ~,t; ~ ~1020560
LXlI.Aa DIXON
F+~ i $t i,nde CouaRjr
Doc Tax i--- Cler' ~ Circuit ~ourt
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To,~.. ,
DECLARAT~ON OF DOMICILB
STATE OF FLORIDA
COUNTY OF ST. LUCIE ~
Thia is my Declaration of Domicile i~ the StaLe of Florida ~
that I am filing this day ir? accordance and in conforeoity with
SECTION 222.17, Florida Statutes. '
i, cwe~ c~~~~A ~ i,J~c~e ) ~
tplease print your name clearly) II
became a bona fide resident of the State of Florida on /-c~C' ,
19~0 and I reside at /c~ 33 ~4[x/rSn?~~~~~ ~~c~ ,
in the City of Fo,~~ ~c~tc~E F/A '~~r/~!S .
My mailiRg address is: SA~r e_ . '
tif different frora street address)
My former legal residence was in the Ci.ty of 1~i ~o,(~ ,
- State of ~'Yt~ .
~No further statement is required. However, if you wish, you may
insert any pertinent facts such as sale of property or business
! or relinquishment of employment at former domicile, removal of
family to new domicile, purchase of home, ete.)
1020560
' '90 JAN P 4 :21
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` I FURTHER CERTIFY that I will comply with all requirements ~
C
! of a legal resident of this State. I understand there is a
; penalty. for perjury; perjury is a felony and is punishable by
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j : incarceration in the State Department of Correctiona.
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~ • PRINT NAME SI ATURE
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PRINT NAME SIGNATURE
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Sworn to and subscribed before me this Z~- day of
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F DOUGLAS DIXON, CLERK OE CIRCUIT ~q•~'
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BY : ~L--c.-c-t~ .1 . r ~t_-~~_-Ea _.c-1 U r.~' jV~i •
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Deputy Clerk ~i~"•-.~~,JM[SPy%~Q.~C'
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~ ~oUN{V.F~ (SEAL)
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NOTARY PUBLIC,'State~of
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§ MY COMMISSION EXPIRES:
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' eooK 67~ ~cE 603
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