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DECLARATION OF DOMICILE
STATE OF FLORIDA ~
COUNTY OF 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, (OI~) Goff, William M
tplease grint your name clearly)
became a bona f ide resident of the State of Florida on December 1,
19~_ and I reside at 1902 S 8th Street~ ,
in the City of F't Pierce, Fl 34950-~131 .
My mailing address is: Sa~.ie -
( if different from street address ) •
M j fnrmnr 1 P~a i YPCI /~P1'~nrr ~r~g 3n t~;}~~ ~yyl ~~as~ ~
State of nx .
(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. ~J~J 26 p3:(!4
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I FURTHER CERTIFY that I will comply with all requirements
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 Department of Corrections.
' William M Goff ~ - U n
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` PRINT NAME SIGNATURE ~
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; PRINT NAME SIGNATURE
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~ Sworn to and subscribed before me this 25 day of ~anuar ,
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s DOUGLAS DI?{ON, CLERK OF CIRCUIT COURT
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Deputy Clerk - ' ~ ' , .
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NOTARY PUBLIC, State of Florida . ~
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& MY COMMISSION EXPIRES ~ ' ~ _ ; ,
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