HomeMy WebLinkAbout0747 ~9etlnrnlinn af ~omticil~
STATE OF FLORIDA 1022055
~ • COUNTY OF ST. LUCIE . ' '
This is my Declaration Domicile in the State of Florida that I am filing thi
day in accordance and in.conformity ~+ith SECTION 222.i7; Florida Statutes.
,
I, (We), p .D, ~ i.. I C~ ~ I e.
p ease pr nC your name c ear y
became a bona fide resident of the State~of Florida on 19~
-and ? reside et : g " o~ ~ L L
in the City of ~a G-u ~ ~ L- ~ 3
My mailing address is: .
i f eren rom s reet a ress
My f ormer le al residence w8s in the City of ~~y ~'1/0 ~ c1 S h~l~ G-
State of ~ •
(No further statemenL is required. However, if you wish, yo~ may i~sert any
pertinent Facts such as sale of praperty or business or relinquishment of
employment at former domicile, removal of family to new domicile, purchase of
home, ~etc.) , •
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I FUF~THER CERTIFY I will comply with all requirements of a legal resfdent of ~
' this State. I understand there is a penalty £or perjury;perjury is a Felony
~ a~d~is punishable by incaration in the State Department of Corrections. ~
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~ PRINT NAME S G ATURE ;
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~ PRINT NAME • SIGNATURE
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~ Sworn to and subscribed before me this ~day of , 19~_
~ DOUGLAS DIXON, CLERK CIRCUIT COURT
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' RECORDING INFORMATION
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~to~~z,ya ~~~r, tate of F~ or,c~ ~a 1022055
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~sy ~Cocr~miss~h eXpires: 6
; ` _ . • . ~0 JAN 29 P 2 •5
~ y COfi:(L:Si:o,: ~x~.res ~ec. 2u. 1990 !1 ~
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~y Its~r C+~_l;.~~~+aa cnti i - .D i
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( seal) • - . • ,?t}t1r,?. c ~ ~?~xOk i.t
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g Kcc Fee S Ut)I.;C;`AS ()14()'V
~ Add Fce S___________ St. Lucie C~~i~nty ,
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; Uo~ Tax 5_ C'ler~ Cinuit Court
I n t Ta x 5 ._,,t ~Yi~ -
A:p•ii,~ (~I~rk
Total S r'- T
r ec~K S75 P1lGE 747
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