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S?AT~ OF FLORIDA I0226~.5
+ • COUNTY OF ST. Lt1CIE . . ' '
This is my Declaration Domici~.e in Lhe Stete of Fl.orfda thet I am f~Iing t
day in accordance end in.aonfoi'mity ~+ith SECTION 22,2.17~ F'lorida Sratutes.
I, (We), ~ ~ ~
p ease pr n•your name c ear y,
became ~ a bona f3de resident of the SLete oF Florida on ,-i 19_ _
-and I reside et - ~ ~-'rfi'~~'~~~-- ~ ~
~ = ~
~ i~ the Ci ty of ' i~ -
My maf Iing address is~ ~l~"l~- ~
rnm g ree a ress
~ii ~.::~e="'.=
~ty former Iegal residence was in the City og_ ~-,~~'f..~ ~'t=~~_
S L a t e o f • ~
(No further ~tatement~fs~required. However, iF you wish, you may insert an
pertinent faeCs such,as eele o~ property or business or rel~nquishment of
employment at lormer domicile, removal of family to new domic~le, purchase o
home, etc.} . ~ ~
I FURTHER CER'fIFY I vitl comply t~rith a12 requirements of e Zegal resident .
this State. I understancl tl~ere ia a penalty for perjury;~erjury is a Felony
a~d~fs punishable by faceretion in the State Departaaent of ~or ~ ctions.
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PRINT NAME ~ SYGNATURE
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PRINT NAriC ~ SIGNATURE .
SWOrn to and subscribed -before me thia ~dey oi= C~-~~ `~L , ig~
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RrCORDING INFORMATION
Notary Public, st~te of ~ 10 2 2 6 d 5
r~ty ~rmi.ssiori ~cpire"s: . - . ° ~ • . .y0 JAN 31 P 3 ~3b
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• . . r lit C• i
~Seal) ~ ' D~tJC~I', ` r'~Xl.h , .
`E' ~npUGLAgDIIC~N Si..:~i:~- :-"1NT'
g,ec Fee i---~""'.'~ SL. Lucie Contsh?
pdd Fee 3----°"""""' ~erk of
~ircu~t Ce~ut
Doc Tax S--~---'~... B~ ' F~
Ini T~x i---""~' Deputy Clerk
Total i ~-=""y"'~ • ~
~ • . • ' BOG!( U~~ r^~GE~~~.~ .
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