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DECLARATION OF D(3MICILE T.: 1l S C°
STATE OF FLORIDA '
COUNTY OF ST. LUCIE
This is my Declaration of Domicile in the State af Florida
that I am filing thi$ day in accordance and in conformity with
SECTION 222.17, Florida Statutes.
I~ L~pez, Victor M ~
(please print your name clearly>
became a bona f ide resident of the State of Florida on November 28, ~
~g 87 and Z r~S2C~.2 at P~se~~2~ A1 ,
in the City of Ft Pierce Fl 34982 •
My mailing address is: Same -
tif different fram street address} '
My former legal residence was in the City of Aguascalientes ~
State of Mex co -
(I3o further statement is required. However, if you wish, you may
insert any pertinent facts such as sale of property or business
or relinquishment of employment at former domicile, removal of
family to new domicile, purchase of home, etc.)
~90 FE8 °2 A 9 :14
1023028 ~~t
~ N R~ C!~N
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~ I FURTHER CERTIFY that I will comply with all requirementa
i of a legal resident of this State. I understand there is a
' penalty. for perjury; perjury is a fel~y and is punisha e by
~ incarceration in the State Department~o (Corrections.
~
Victor M Lopez L/~~i~l~/" ~
!
~ PRINT NAME SIGNATDR
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i
~ YitiNT NAME SIGNRTURE
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~ Sworn to and subscribed before me this 25 day of January ,
~ 19 90 .
~
~
~ DOUGLAS DIXON, CLERK OF CIRCUIT COURT
•
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BY : .ti~ , . ' ~ :
Deputy Clerk .ti~ y ' ~~•v''G~,~_
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NOTARY ?UBLIC, State af Florida • '~~c~`
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H_~;f.RY FU3LIC STATE OF FLGRIDA • ,
MY COMMISSION EXPIRES : N.Y ~:~":~ISSIU~ EY,P. CCT.13.1993
..r~u ~ . UND.
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