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STATE OF ~LORIDA 14z264 ~
COUNTY OF ST. LUCIE . '
This is my Dec2aration Domici~e in the SLeLe of Floride that I em filf~g t
day in acccrdence and in.~+~nfai'mi~y ~ith SECTION 222.17; FZorida Statutes.
I ~ ~ We ~ ~ ,
F"'--'° ~ p ea~~ pr~~ you
eme
clear y '
became ~ a bona f ide residenL of tbe State o~ Florida on ..2 19 ~s~.~ ~
•and `f `resfde et ~,~~~f S ~ c ~C ti~
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in the Ci ty of_=
~~o..~:~d..~ -~-/o ~.sF~s -l.
t•ty mail3nR sddtess is: '
`~.t rILL~~~:LGi~L "ai:aw _ A~~YPQB
My former legel residence mes fn the City og ('i~~ ~
S L a t e o f 121 ~ S~.~ • ~ .
:
(No further stetea~ent is required. However, if you wish, you may insert an
pertinent facta such.es sale of property or buai~ess or relinquishment of
employment et tormer domic3l~, removel. of facaily to new domiciLe, purchase o
home, etc.) . ~ .
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I FUItTHER CERTIFY I will cor~ply ~rrith alI requirements of a legal resfdent
this State. I under9taAd there ie s pena2ty for perjury;~er~ury is a Felony
and~is punishable by inceretio~ in Lhe State Department of Corrections.
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PR I NT [~AME ~ S GNATU
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PRiNT Nar~E SZGNATURE . '
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Sworn to and subscr~bed -before ma this __~C___day o~ i9~ ;
DO LAS D , CIRCUIT COURT +
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" - . RL'CORDING ~NFORMATION
Notary Public, Stafie of 1 ~ z z 6 4,~
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r~ty ~armis§iori ~cpires: _ - . . . ' '90 JAN 31 P 3 :34
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tnt Tax S~ ~Y
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~ ~ Soo~ 675 ~~~rF 2115
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