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STATE OF FLORIDA 10z498,~ ~ .
COUNTY OF ST. LUCIE '
This is my Decleratio~ Domicile in the State of Florida that I am filing thi
day in accordance and in.conformity vith SECTION 222.i1; Florida Statutes.
I, ~We), ov~
- p ease pr nt~your name c ear y
became ' a bona f ide resident of the SLete ~of Floride on ~3 19
-and I reside at__ _[.~~Z `~o`ns~~ ~v ~
~
in the City of P• S~~--• FL. 349 S 3
My mailing address is: ~
f eren rom s r~eet a ress
My f ormer legal residence ~as in the City of ~ e v e~Q-~
State of o Ni ~ . ~
. .
(No further statement is required. However, if you wish, you may insert a~y
pertinent facts such_as sale of property or business or relinquishment of
employment at former domicfle, reaaoval of family to new domicile, purchase oE
home, 'eCc. ) , .
_
I FURTHER CERTIFY I vill comply aith ell 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 Department of C~orrectfons.
i1e, ~e ~~9 ~P H H~~ ~,~o~ s r~
PRINT NAME ~ SY6NATURE
PRINT NAME • SIGNATURE .
Sworn to d subscribed before me this ~day of Gl',GG , 19
LAS D , CIRCUIT COUItT
Dep ty er ~
. . RECaRDING INFORMATTON
yotary Public, State oF 1~Z0964
~y Cor~mission expiress • ~ .'S~ JAN 24 A10:51N
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r~,., : - _ Rcc Fce S ~ 'D ~ (}VUGLAS UtXON ~
~ Add Fee S St. Luci~ Couniy
:t - Doc Tax g Gerk of Circ 't
"4; " tnt Tax s ,B Co
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'1~,, cc~~ ~ ~,•,,r Deputy Ckrk
-''i4? a~+?? Tutal ~ _ ~
. . ~ eoax 674 P~Ei5f~
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