HomeMy WebLinkAbout0834 _ ~ . . ~eclurrifi~n at ~vm~,~~r~„~
S?ATE ~ OF' FLOR I OA ! ~ Z 21 O e .
COUNTY OF ST. LUCIE '
This is my Oec~azetion Domicile in the State of Florida that I am fili~g th
day in accordence and in.confoi~mity with SECTI~N 222.17~ Florf.da Statutes.
,
I, ~W~~, ~~A,}l~ s ~ L~ti'~~ ~~vT~~. z ~o
p ease pr n~ your name c ear y )
became ~ a bona fide residenL of the SCaCa of Florida on 19
`,~„___r_
-and I reside +~t ~l'-=~ ~~C~'~,~~~~?/t'
~ in the Ci ty of ~C~n' i ~ t • _ ~ L __r_ ? ~ ,
My mai23ng address is: ~
i, d#£ eren rom street s dress
Ny former legel residence was in the City of Gl~~~L~-/I~mS ~'iLL~
S L a t e o f ~~'~'_K._,_ • ~ ~
(No further statement~is required. ~~owever, i~ you wish, yov may insert any
pertinent facts such,as eale of property or business or relinquishment of
employment at foriaer doaticiZe, removal oF family to new domicile, purchase of
ho;ne, sic. ) ~ •
I FUATHER CERTIFY I vill comply with al~, requfrements of a Iegal resident
this State. I understancl there is a penalty for perjury;~erjury is a F'elony
and~is punishable by incaration in the State Department of C~orrect~ons.
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PRINT NAME ~ S2GN TiIRE ~ ~
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PRiNT NAME SiGNATtJRE .
Sworn to and subscribed-before me this ~day oF , 19 ~~c~
DO DIXON~ CZRCUIT COURT
By '
e tyCer
: ~s„~,_ , RL'CORDING ZHFORMATION
:~otary Public, State of
t~;y- c:armission Expire"s: _ . . . 10 2 210 8 ~
t "90 JAN 24 P 3:54
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