HomeMy WebLinkAbout0828 . . ~Pw~rn~~~~~~
STATE OF FLORIDA ~ OZZ 1 O z •
t• COUNTY OF ST. LUCIB '
This is my Declaretioct Docuicile in the State of Florida that I em filing tr
day in accordance end in.cort~ormity with SECTION 222.17; Florida Statutes.
I~ (We)~ ' l~~v U~~G C~ L c-~ ~ o~" L- ,
' p ease print~ you name c ear y N, s ~-U ) S>
became ~a bona fide residettt of the SCate oF Florida on ~~~s fg:.G• 19
,
-and I reside at ~r~^"'~~-,~, S_i_=,r~or7- S~ L«~~e ~G 3~S
r~~
~ in the CiLy of
My r~ailing address is: ~
f dtf eren rom street a ress
t~fy former legal residence was in the City of ,~Q ~
Siate of ~~~.~f~ • ~
(No further statemenC~is required. However, if you wish, you may insert a~y
pertinent facts such.es eala oF property or business or relinquishment of
employment at !`ormer domicile, removal oF family to new domicile, purchase oE
home, eic.) • ~
.
I FURTHER CE1tTIFY I~ill comply with all requirements of a legal resident ~
this State. I understand Lhera is 8 penalty for perjury;~erjury is a Felony
and'is punishable by inceration in the State Department of Corrections.
•
~ ,~l ~ ~ G c,~ ~V GT ~~'-~r~ c~ ~ ( cc- ~ ~
. . ~
PRINT NAME SIGNATURE
C~ ~ G~ ~tl ( o c~ r N" _ "
. ~ U"` .+:~~1
PRiNT NAt1E ~ SiGNATURE .
Sworn to and subscribed -before me thia •~~day of , 19`~t'~,
- ~ D ON, ~RK f M , '.~RT .1
- ,
8y,_ ~ ~ ~ , ~ •-t~_
eputy er :7 ; .
. j. ; i ;i : . .
- RECORdING INFORMATION
:~otary Public, state of ' ~ Q 2 z 1 0
~ ` ~
t•iy Ccmnissiori bcpires: - ' ' . .
. ~ '90 JAN 29 P 3 ~51
t g~t
~~E: 'i~ , . '
~Seal ) ~ Fee i ~ _ ~ nOUa1.A9 D1ZON i;~U~ l_ ~ ; X GN .
~ Sk LuCie Connty i ~ , ~ . . r ~ I k ; ~ .
Add Fee s -
Doc Tax S - Cle o ircuit Court
Int Tox S By
Uey~~~Y Glerk
Total S -
. ~ . BOGM U7~ PA6E O~~ . .
- ~ , _
~~~~t
~,~v~~~., ..,s,