HomeMy WebLinkAbout2116 _ ~ , ~ ~Ietl~rt~tiar~ ~n ~w~~~~<<„r
$TAT~ OF FLORIDA 102Z6d3 . ~
COUNTY OF ST. LUCIE . '
This is my Declaratfo~ Doa~ici~e in the State o~ F2orida thet I em ffling t
day in accorda~~~ and itt.aot~~gi~it~? t+tth SECTION 222.17; Florida Statutes.
Z~(We)~ ~ ~
, p ease pr your name c eer y
became~a bona f3de resident o~ the SC1tte~oF Florida on_ ~~-~t~1 29_~
•and T reside gt c~• Y .
~ in the City of i ~ ~
Mv mailing address is: ~ ~ -L-
~ eren rnm atree a reas
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My former Iegel residence was in the City of c~~~2.~~;,r1t- ~i~~
S t a t e o f ~ r v~ _~,5~,~,_,,, _ . " ~
(No further stateiaent.is~required. Howaver, if you wish, you r~ay insert an
pertinent facts such.es eale of property or business or re2inquf.shment of
employment at l~ormer domicile, removal of family to new domicile, purchase o
home, etc.) . ~ •
; . .
I FURTHER CEATIFY I vi21 ce~aply trith a31 requirements of a tega~ resident
thfs State. I und~rstand t.here te e penelty for per~ury;per~ury is a Eelony
and'is punishable by incaxeLion fn the Stete Department of Corrections.
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PRINT NAME ~ SI NATURE
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PRINT NA{~fE ~ SIGNATURE .
Sworn to and subscribed-befor~ me this dey oE ~ , 19~
DO LAS ~ CIRCUIT GOURT
B - J GGr
e uty er
RtCORDING INFORMATION
t~cotaiy Public, stete o~ ~ 10 ~ 2 6~ 3
.
~~y ccnmiss.ion bcpires: - - . . . • ~ '90 JAN 31 P 3 :35 ~
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~ r,:: ti~~. s • j~ I~OIJGLAS U(XUV )h1 .
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` ~~;1~i F~c S St. Lucie ~Cuunty
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. • D<<c Tax S Ci~rk of Circ it Co}~ri
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~j 1 n t' Ta x 5.~~_ By ~i~.
- [~cputy Clerk
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~ ~ ~ ~ ° ' 675 P,,c.21~.6 ~
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