HomeMy WebLinkAbout0507 . ~Beclnrrrii~n ut ~vo~~r~~~
STATE OF FLORIDA OZ 9 9
~ • eOUNTY OF ST. LUCIE , • •
This is my DecZaratfon Domici~e 3n the SCete of F].orida thet T am fi~ing t1
day in accordance and in.aonfoi~aaity viLh SECTI~N 222.17; Florida Statutes.
~ ,
i~(We)~ ~ . / % ~ ? ~ ~ S~
p ease pr n~your name c ear y
became~a bona fide resident of the St~te oF Florfda on~.~- 19
~
•and I reside at i'~ / ~~`"'r~~!~'~L-t'p-~ -~'cG`
_ ~ ~
~ in the Ci t of ,r ` ~ ~
y , ~ ~ n _ vr„{- ~ ~f,~ >
~ ~
My cnailin~ address is: ~
f eren rom street a ress
~fy forcaer legel residence wes in the City oF~~~.~n~,;Z~
Siate of . ~ ~
~
(No further statement is required. However, if you wish, you ma~y insert a~y
pertinent facts such.as sale of property or business or rel.inquishment of
employment at lot~aer domfcile~ recaoval of family to new domicile, purchase oE
. .
s.,,...~ otr~ _ ~
d i ~ _ _ - -
_ ,
I FUBTHER CERTIFY I~rill comply with all requirements of a Iega2 resident ~
this State. I underetand f.l~ere is $ penalty For perjury;~erjury is a Felony
and~is pu~ishable by inceration in the StaCe Department of C~orrections.
~ ~
~
`~~L.1. ~ ~ ~
PRINT NAME ~ SIGNATURE
~
PRINT NArfE ~ SIGN4TURE .
Sworn to and subscribed -before me this -~_,~__~4~__day of ~ , 19 Q~,
e_~ D4~L~1S DIXO~ CLERTC CI8£UIT COURT , ~
Y C
~
eputy er .
, .
RrCORQING INFORMAT~ON
:,totazy Pub~ic, state of 10218 9 9
.
c•fy Ccx?missiai F~cpires. : - • . .
. ~ •gp JRN 29 Ai1 :Oy ~
t
C~al) • . • FILtC~ :.~i~r aE(
_tJOU(3I.ASDIZON ~OUGi:f::~ (_''XOk t;.
Rec Fee ~ o ` 1. L i ~ ~ ; . ; ~ ' 1!r i . .
Add Fea S~ Lncie CoaA~ . .
, poc Tax i - Clerk of .
ircui! Caturt
Int Tax ~ BY '
Deputy Clerk
Totsl S
. . • ~ • ~ V~i~ .
t ~ _ . _ :