HomeMy WebLinkAbout0794 . ~ , ~ ~tc~~rrf~~n us ~ui~.. ? i.
STATE OF FLOR IOA 1 O 2~ O g 1 .
COUNTY OF ST. LUCxE . '
This is my DeclaraCioct Domicile in the Stete of F1~orida that I em filing t
_ day in accordance and in.cottPo~i~y vith SECTION 222.17; Fl,orida StaCutes.
I , ( We ) , ~ ~ / .f
~ • / ~.1_ I~/~ s • ~ / L L-.~
. p eese pr n~ your name c ear y
became ~a bona f3de resideat of the State of Florida on, Y,~. ~._____,_19,~_
•a nd I re s ide e t `r Q cw~-~. cri
~in the City of ~
My mailing address is: , S_ '
eren rom aLree e ress
My former Iegel residenae was in the City oF ~
State af ~ .?.S o / . ~ ~
(No further statement.fs~required. However, i€ you w~sh, you may insert an
pertinent faets such_as eale of property or business or relinquishment of
employment at former domfcil.e, removal of family to new ttomfcile, purchase o
home, etc.) ~ •
I FURTHER CERTIFY I~rill coa~ply tritts 811 reqnirements of a lega2 resfdent
thfs State. I underatancl ehere ia a penalty for perjury;~erjury is e Felony
and~is punishable by fnceration in the State Department of Corrections.
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PRINT NAME ~ SI6NATURE
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PRINT NaFfE SxGNATURE .
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Sworn to nd subscribed -before me thi8 ~~___day of :L,.~.<,~..~ , 19
UG DIX , CZ~CUIT' CAUItT ~
~ ~ /
eputy er
' _ RrCOROING INFORMATION
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r~~y cc.xrmis§iori Expit-es: . - . . . .
" ~ '90 JRN 29 P ? :s 1
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,j _ LLp~ty Clerk .
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