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STATE OF FLORIDA 1022~ d 2 ~
COUNTY OF ST. LUCIE . ' ~
This is any Dectaration Doailcile ict Lhe Stete of Fxorida thet I em filfng t
day in accardence and 3n.4onFo~at3ty vith SECTIQN 222.27~ Fl.orida Statutes.
I ~ ~ We ~ ~ ~ _S ~ .
~ ~ T7~,~-
, p eese pr a•your neme c e~r
. became ' a bona fide residenti of ~he St te oF Florida on z' 2 ~ 29 ~G'
,
•and I resfde at ~ ` • l~c.~ '
~ i~ the Ci ty of '7~ c~. L- ~
My mailing address iss '
eren roat a ree a ress
My former Iege~ reaidance vae in Lhe City of ~t~;~G ~
Siate of ,~Y~ G~' ~'z ~ . . .
. . .
(No further statement fs~requfred. However, if you wfsh, you may insert an
pertinent facta such,as eala of property or buainess or relinquishroent of
employment at former damicile, recnoval of family to new damicfle, purchase o
_ home, etc.) . ~ ~
~
f
• .
I FURTHER CEItTIFY I trill coraply trith el.l requ~rements of a Iegel resident
this State. I umderetead tl~ere is a penalty for per3ury;perjury is a Felony
and~is punfshable by inceretion in Lhe State Department of Corrections.
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PRINT NAME ~ ~ ~ SIGNATURE
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PRiNT NAP~E ~ SxGNA7'IJRB .
Sc~orn to a subscri~ed -before me thfs „~~~~~~~~,~T__dey of
~ ~CC~ , 29 G'
n
D D CZRCUIT COUkT
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' ej~U S? 6C
. RrCOROING INFORMATION
Notaiy nublic, state o~E ~ ~ 10 2 2 3 4 2
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My c«~~s~.or; ~i~: . - . ' ~ ' JAN 30 P 1 ~5~ ~
t ~N
y 3;
r IL~ i . 2~ C;:
rs~~~ ' ~ ~ ~ ~OUG~~ ~,~~xc,r. ~ ~
" Rec Fe~e ~ 0~~ S i. LU: : r,~ ~;!t?
Add Fee = ~ ~
Doc Tax Lad~ Cop~
~ Int Tux a=„~~B erk of~rqjt(jp~
y f~v
Tota! s ~U ~ Deputy Cj~
. . ~ . . ~ ~oox 675 pA~E~.38~
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