HomeMy WebLinkAbout0748 ~ . . ~ettntnii~n ~t ~qmlr~~~
STATE dF F'LOR IDA ~ Oz z a~J G.
COUhTY OF ST. LUCYE '
This is my Decleratfo~ Domici~e in the StaCe of Florftla Lhat x em filing t
day in accorden~e end in.coni'u~mity vith SECTION 222.i7~ Florida Statutes.
j , ( w~ ) , ; ; f! / ~ C~ - ' 'j ,~-=.~~~';,d 5
p ease pr n• yaur name c ear y
became~a bona fide residenE of the State oF Florida on /~19~
•and I resid~ t~t ~q~ ~ ~ T
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~ in the City of y~ 5
My mailing address is: ~
i £ eren rom street 8 ress
My form~r legal re~idence wes in tha City of_ 1~~C~,C k 7~~/~,~
State of S~~ ~G~l . ~ ~
(No further statement~is~requited. However, if you wish, you may insert an
pertinent facts such.as eale a€ property or bus~ness or relinquishment of
employment at former domicile, removal of family to new domicile, purchase o
home, etc.) ~ •
Y FllRTHER CERT~FY I wi11 compl.y vith all requirements of a legal resident
this State. I understend Lhere ie $ penstty for perjury;Fer~ury is a Felony
and~is punishab2e by fnceretion in the State Department of Corrections.
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PRYNT NAME SI6NATURE
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PRINT NAAfE ~ SYGNATURE .
5worn to and subscribed -before. ,~Q,; tthis ~`t`~ day of 19 ~ v
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AIfUGLAS 1?IX • ~ ~~'~E~'i~` 1a9~T
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BY _ ~ ~ .
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Nsy cc~~missiori E~piz~es: . ~~0 JAtV 29 P 2:57
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Add Fee ~ _~„SL Y,ude ConAt,~y •
Doc Tax ~ Cie~k of 'n,yit Comt
Int Tax = By %
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