HomeMy WebLinkAbout0749 . _ . ~ . . . ~ ~t~etlutt~liptt i~i w~~tc+~~
STaTE oF FLORiOA ~ 0 Z z 0 S?
COUNTY OF ST. LUCIE . ' ~
This is my Declarb~ion Domicile i~ ~he Stete of FJ.oride thac I am filing t
day in accordence an• n.aon.fo~cnity Mi SECTIQN 22~.17; Florida Stacuces.
~ ' ~
I, (we), , ~i `
• p ease pr n• your ame c ear y
became~a bona fi.de residanL o~ t e State of Flori on ~ ~ ' ~ r 19~
•and I reside ~t ~G~- ~ ~ -
~ in the Ci Ly of I C ~ ~ s
My rnailing address ~s: ~ ~ f' ~ ~
i df£ eren rom stree a ess
~ ~
~ty former I 1 resid nce wae in the City of ~ c~ ~
State o~ ~ ' ~S • ~
(No further statement.is required. However~ if yau wish, you mAy insert an
pertinent facts such_as ~ale of property or business or re2lnq~ishment of
emp2oyment st former domici2e, removal of family to new domicile, purchase o
home, etc.~ . ~ •
.
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I FURTHER CERTIFY I t~ill coa~ply vith all requfrements of s Zegal resident
this State. I understancl there ia e penalty for perjury;perjury is a Felony
and~is punishable by fnces8tiion in the State Department of ~orrections.
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PRINT NAME ~ SI~NATU
~
PRiNT NaME ~ SiGNATURE .
Sworn t and subscribed-beFore ms thi8 ~day o~ f 19 ~ U
LAS DT.XON,~^ GIRCUZT (;OURT
By
a uty er c
RrCORDING ZNFORMATION
Not~ ~bii~, state of ~ 10 2 2 0~ 7
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bty crnmissiori bcpires: - • • .
" ~ '90 JAN 29 P 2 :Sb
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