HomeMy WebLinkAbout0833 1~Beti~rnti~n uf ~omicile
STATE OF FLOR IDA , i O2 ~ 1 O~
COUNTY OF ST. LUCIE ~
This is my Declaratio~ Domi.cile in the State of Florida that I am filing thi
day in accordance and in.conformity with SECTION 222.I7; Florida Statutes.
I~(We), ~ GU~i A?~ ~f ~{Q-I~CIA
p ea pr nt~your ~ame c eer y
became ~ a bona f ide resident of the Stete ~of Florfda on~OV - 02 a- 1~9~_
-and I reside at D$ E ~ Q KS 4~t RE . vt~
~ in the City of `~L~~ .~q 5
My mailing address is: •
i d~f eren row s reet a ress
My former legal residenee was in tha City of Bl~~ E~ ~ c-J c~ c~ ~
State of N Q~ e~<<~ •
,
(No further statement is required. However, if you wish, you may insert any
pertinent facts such as sale of property or business o'c relinquishment of
employment at former domicile, removal of family to new domicile, purchase of
hame, 'etc. ) '
I FURTHER CERTIFY I will compl.y with 811 requirements of a legal resident of
this 5tate. I understand there is a penalty for per~ury;perjury is a Felony
~ and is punishable by incaration in the State Department of Corrections.
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; PRINT NAME ~ SI6NA RE
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~ PRII~T NAME • ~ SIG TURE
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~ Sworn to a~d subscribed before me this i ~ day of , 19 ~ d
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~ 0 S 1~I CIRCUIT COURT ~
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~ ~ Dep y C er
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~ RECORDING INFORMATION
~ ?lotary Public, State of 202210?
~fy Commission expires: • - '90 JAN 29 P3 ~54~
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