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DECLARATION OF DOMICILE int 1~uu g~,~~,~By
STATE OF FLORI DA . Tutul C~
COUNTY OE ST. LUCIE
This is my Declaration of Domicile in the State of F'lorida
that I am filing this day in accordance and in conformity with
SECTION 222.17, Florida Statutes.
I ~ ~ Flood, David F
(please print your name clearly)
became a bona f ide resident of the State caf Florida on December 20,
19 89 and I reside at 8800 S Ocean Dr, Unit 704 ,
in the City of Jensen Rch, Fl 34957 ~
My mailing address is: same -
~if different from street address) •
My former legal residence was in the City of Fond Du Lac ,
State of W~ .
(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.)
'90 JAN 26 P 3 :03
1021788 gi~
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; I FURTHER CERTIFY that I will comply with all requirements
; of a legal resident of this State. I understand there is a
i penalty. for perjury; perjury is a felony and is punishable by
~ incarceration in the State Department of Corrections.
~
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; Dav id F Flood ~ ~ ~
; PRINT NAME SIGNATURE '
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~ PRINT NAME SIGNATURE
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~ Sworn to and subscribed before me this 2'~ day of January ,
~ 1 g 9~ .
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~ DOUGLAS DIXON, CLERK OF CIRCUIT COURT
BY: . ~
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Deputy Clerk . ; ..~.....,,.,~p_,. ~
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NOTARY PUBLIC Florida I ~ ~uJ~ ~ • .
, State of
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; PfOTARY PUBIIC STATE Of FLORi011 ~^'.!•Z: t
' MY COMMISSION EXPIRESNY ~d'~"ISSIOM EXP. Q~ 1993 ,
~ 8~ ERAL INS. UVD.
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eooK 675 ~cE 319
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