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A~±d Fee i - St. C.uc~c C~ur., :
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DECLARATION OF DOMICILE
STATE OF FLORIDA '
COUNTY OF ST. LUCIE
This is my Declaration of Domicile in the State of Florida
that I am filing this day in accordance and in conformity with
SECTION 222.17, Florida Statutes.
RX ~We) Williams, Lorenzo & Maxine ~
(please print your name clearly) (1983 Lorenzo)
became a bona fide resident of the State of Florida on (1975 Maxine)
19 and I reside at 3015 Navaio AvenLe •
in the City of Ft. Pierce, FL 34946-8955 .
My mailing address is: same ~ •
(if different from street address)
My former legal residence was in ti?e ~izy oi Uurnam ,
State of North Carolina (Maxipe) Jamaica (Lorenzo)
(No further statement 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
family to new domicile, purchase of home, etc.)
~0 JAN 26 P 3 :00
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` I FURTHER CERTIFY that I will comply with all requirements
e of a legal resident of this State. I underst~nd there is a
~ penalty. for perjury; perjury is a felony and is punishable by
~ incarceration in the State Departrrent af Corrections.
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~ PRINT NAME IGNATURE` ~
~
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~ Maxine Williams
~ PRINT NAME IGNA URE
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~ Sworn to and subscribed before rle this 24 day of January ,
~ 19 90 •
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~ DOUGLAS DIXON, CLERK OE CIRCUIT COURT
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BY ~ ~ - JG;~~':.
•Deputy Clerk r`'1~ J ~y
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NOTARY POBLZC, State of Florida ~`'.t ~..~',,<<'~'~`
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MY COMMISSION EXPIRESE`~'~'~ y~. •
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