HomeMy WebLinkAbout1569 ~EieCl~t7fll~» , tii ~omtct,e
STATE OF' FLOR I OA i ~ Z 0 9 g 7
COUNTY OF ST. LUCIE '
This is my Declaratio~ Domicile i~ the State of Florida that I am filing thi
day in accordance and in.conformity vith SECTION 222.17; Florida Statutes.
I~~We~~ ~o ~~n~ 'f-' L-~._-o''`~ .~',/E-~~Si ~
p ease pr nC your name c ear y ,
became ~ a bona f ide resident of the Stete ~of Florida on /o~ - 19 I
•and I reside 8t ~.5~ ~ ~ - ~b ~ C
~ in the City of_ ~"~r% ~'1~ L-u~iC 3~~~~~
My mailing address is: S J~vt ~~S ~ o~~ ' ~
i f eren rom s ree e ress
My former legal residence vas in the City of f~t~~~ ?v7?4~ f~ D~v,~1 S~~l~
State of /U~~ •
.
(No further stateraent 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 femily to ne~ domicile, purchase of
home, 'etc. ) , •
I FURTHER CERTIFY I vill comply witt~ all requirements of a legel resident of
this State. I understand there is a penalty for perjury;perjury is a Felony
and~is punishable by incsration in the State Department of Corrections.
i ~ ~ ,
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; PRINT NAME ~ SI A E ~
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i PRINT NAME • SIGNATURE .
~ .
~ Sworn to and subscri~ed before me this ~,o"Z
~'day o ~ , 19~
~
~ ~'pU LAS DIXON RK CIRC~3IT COURT
~ ~
_
~ eputy C er
~ • . ~ RECORDING INFORMATION
~ ?lotary Public, State of ~
~ 1020987
yy Com~nission expires: -
• . ~ ~ 'S~0 JAN 24 A10 ~ ~
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~ Tatal i t=- ~ . ~
~ eoo~ 674 PAGE1569
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