HomeMy WebLinkAbout0751 . . ~er,lnrt~tian ~ir ~o~n~c~~~
S?ATE OF FLORIDA 102205~
COUNTY Of ST. LUCIB •
This is my DecZareCfott Domicile in the State of Flori88 thet I am filing t
day in accordance and in.aot~t'o~:cnity v~th SECTION 222.~~; FZorid~c Statutes.
I, (We),~ ~t 1~i~ ~ •
. ~ p ease pr n•your name c ear y
became~a bona fide residenL og tha State of Florida on 1C. 1,(,c~ 19
-and I reside at , . c~c ~ ~ , ~
~ in the City of t ~ < < ~ ~ C_
My mailing address is: ~:1 ~ ~ '
(if dtf eren rom stree a ress
rfy f orcaer leg~l residerce vas in the Ci ty of ~i ~L=~c--~
a
S ta t e of ~'t `,"'r + 1, ~ '
(No further statemenL is required. However, if you wish, you may insert an
pertinent facta such.es eale of property or bu$inesa or relfnquishment of
employment at lormer domicile, rea~oval of Family to new domicile, purchase o
home, etc.3 ~ ' ,
. r._._._.
I FURTHER CERfiIFY I vill cou~ply wifh ell requfrements of a Iegal resident
this State. I underaLe~cl there ie a pena3ty for perf ury;~erjury is a Felony
and'is punishable by incaretion fn the State Department of Corrections.
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PRINT ~1AME ~ SIGNATURE
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PRiNT NariE ~ SiGNATURE .
S~orn to and subscribed-before me thie ~day of ' , i9~
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D4 ~ , , ~ CIRCUIT nOURT
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RrCORDING INFORMATION
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A~+d Fee ~ --_-;______SG Lucie Count~?
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