HomeMy WebLinkAbout1996 . ' , v
STATE OF F'LORIDA 1~21204
~ • COUNTY OF ST. Lt7CIB _ . • ~
This is my Osclaratioa ~omicil,e in Lhe Stete of Fl
i day in accordence and in.aonFo~mity with SECTION 222
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I ~ ~ ~~~~~t ~-FZ ~C~ ~ o . '
. p eaee pr •your neme c ee:
.became~a bona tide ree3deAe o~ the Stete~of Florida +
•and I reside a?t ~~~~(~r ~ b« Jti .
~ ~ in the City of+,. ~
o.~~ .5i;,~ti
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My mailing address ist ~-m~. as c~.~~
eren rom s ree a i
t~ty former legal residence vae in Lhe City of,~
ti
S t a t e o f_ _ ~V
: ti ~~y . '
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(No further statement fs ~requfred. However, if you
pertinent facts such.es sale of property or business
employment at former do~oicile, remova2 of femily to n
home, etc.) . ~
i ' . ` ~
~
I
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I FURTHER CER'TIFY I vill comply vith all requiremen
thfs State. I uaderetand Lhere ia a penalty for perju
and~is punishable by inceraLion in the State Oepartmen
~St~ gk~i t~- `~c%~i
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PRINT NAME ~ SIGNATURE
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PRINT NAME ~ SIGNATURE
Sworn to an subscri~ed-beFore me thf8 _L~day oF
]~U D ERI~ CIRCUIT CAUItT
~2-'' ~
` eputy er
Nota~y Public, State of ~ ,
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tfi,~ Corrmissiori ~cpires: - . . .
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~,~Ec31) :_?1_r ' • , ~ n • • I
_ j~l, Rec' ~ee 5~ 'G' d UOUGLAS DIXON
_Fy ~p Ad~ • Fe'~ S---_______ St. Lucit County
' ~ Dac Ta x S
f ~f' Cierk of Circuit our~
; '~i 1 n t Ta x 5_~.-._.__ gy ~
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~ t Ipj ~~rS~,: ~p
c o , '~cputy lerk
~ ~oUKrv Tr~ Tota i S~~l/ .
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. . • • . ~ ~ - 60t114 U7~ PA
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