HomeMy WebLinkAbout1567 ~ip~wu~s.i..•.. G...........•
STATE OF FLOR IDA j 4 9 g 5 . ~
, • COUNTY OF ST. LUCIE . ' ~ '
This is my Declaratio~ Domicile in the State•of Floride that I am filing thi
day in accordance and ir.confo~mity with SECTION 222.17; Florida Sratutes.
I, (We), 5.~,~nn~ (-~i2e, ~ (r~
- p ease pr nt~ your name c ear y tiv
became~a bona fide resident of the State of Florida on ~ 19
-a~d I reside at 9'79 N~ ~~~~?.S c.'` ~uQ
in the Ci ty of S~?P~ Qa~ c~r t A 3 y9-~'~
My mailing address is:
f eren rom s ree a ress
My former legal residence was in the City of -r~'~~ ~
State of ~L~ •
.
(No further statement is required. However, if you wish, you may insert any
pertinent facts such.as sele of property or business or relinquishment of
employment at fora~er domicile, removal of family to new domicile, purchase oE
home, 'etc. ) , •
I FURTNER CERTIFY I will comply with all requirements of a legal resfdent of
this State. I understand there is a penalty for perjury;perjury is a Felony
i a~d~is punishable by incaration in the State Department of Corrections.
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~ PRINT NAME ~ ~SIG ATURE
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' PRINT NAME • SIGNATtJRE .
p Sworn to a d subscri~ed before me this day of , 19~~J
DO S. , RK CIRCUIT COURT
By ~
~ Deputy C er ~
~ RECORDING INFORMATION
~ >otary Public, State of
~ "10 JRfi 24 A10 :5 ~
~ ~y Go~mission expires: • ~
; . ~ ~ 10~0985 8~(
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~1 7f'I~r,; : i!: X "vh ~
(Seal~ ' ~t~r Fce S~~v Ix)~1GLAS UIXON i-i' ~ ~~'~4'
; .1dd Fee S___-- St. Lucie County
~ - Ih~c Ta~ 5 Clerk of Circuit Cou
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i n.•-••~+v Cic~k
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. . . ~0~674 P~1567
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