HomeMy WebLinkAbout1568 . ~rL"1ArAa~ua a~i ~u~~~K~ac
STATE OF FLOR I DA 10 2 0 9 6~ ~
~ • COUNTY OF ST. LUCIE , ' '
This is my Declaration Domicile in the State of Florida that I em filing thi
day in accordance and in.con.forcaity with SECTION 222.17; Florida Statutes.
I (We), = ~ ~ ~ ~/~'S? ~C
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' ~ p eese pr nt~ your name c e;~r y
became ~ a bo~a f ide resident of the Stete ~of Florida on i~~i9/ 3 Q 19~
-and I reside at ~O ~ ,~~~SG~
in the Ci ty of ~7 -
My mailing address is: 'L
f eren rocn s ree a ress
My former le 1 residence vas in the City ofi,~ti~= v~= ~vI ~
State of Ni D •
, .
(No further statement is required. E~owever, if you wish, you may insert any
pertinent facts such as sale of property or business or relinqufshment of
employment at former domicfle, removal of tamily to new domicile, purchase of
home, 'etc.) . •
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I FURTHER CEItTIFY I will comply with ell requirements of a legal resident of
this State. I understand there is a penalty for perjury;perjury is a Felony
t and'is punfshable by incaration fn the State Department of Corrections.
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~ PRINT NAME ~ ~ A E
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~ PRINT NAME • SIGNATURE .
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~ Sworn to a subscribed before me this day of , 19
~ D S, , RK CIRCUIT COURT
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~ RECORDING INFORMATION
~ ?totary Public, State of 1020986
yy Coc~mission expires: • ~ '90 JAN 24 A10 ~5~
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' ~ ` ~-Y{. Rec Fee S~ 'D~ DOUGLAS U ON , .
~ f r~~~ t`> f. ; . Add Fee S St, Lucie Cvu y
~ Doc Tax S Cterk of Ci cu Cous~
t~ Int Tax S ' By
~ ~e+n. a~"' Deputy C1crk
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