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STATE OF FLORIDA 102210 9~ .
C4UNTY OF ST. LUCIE . .
This is my Declaration Dom~cile in the State of FloriBa that I em filing th
day in accordance and in.aonfol~a~ity wl.th SECTION 222.17~ Florfda Statutes.
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I~~W~~~ ' , ~ ~ - %
p eas n~ you me c ear y
became~a bona fid resident of the Stete of Flo~ida on ~19_~~
-and I reside at S '
~ in the Ci ty of ~
My mailing address is: ` : ~
~ e o Lrse re s -
My forcner legal residence was in the City og
State of_ • ~
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(No further statement.is required. Eiowever, if you wish, you mAy insert any
pertinent facts such_es eale of property or businesa or relinquishment of
employment et fortner domfcile, reaaovel of family to new domicile, purchase oE
home, etc.) • '
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I FURTHER GERTIFY I vfll comply with all requirements of a Iegel resident
this State. I understand Lhere ia a penalty for perjury;perjury is a Felony
and'is punishable by inc.eration in tl~e State Department of C~orrections. ~
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p~ I rtT NACiE S IGNATURE
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PRiNT NAriE ~ SiGNATURE a
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Sworn to an .subscribed -before me this - day oE 19~ j
D ~ CIRCUIT COURT / ~
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eputy er
R£CORDING INFORMATION
~ratary Public, state of I 0 2 2~ ~ 9
, r•1y ~cmmissiai ~cpires: : • ' '90 JAN 29 P 3 :55 ~
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C3 ~ Add Fee $ St Gncie Connb .
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