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Uc;~uty Clsclt
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DECLARATION OF DOMICILE
STATE OF FLORIDA
COUNTY OF ST. LUCIE
This is my Declaration of Domicile in the State of Florida
that I am filing this day in accordance and in conformity with
SECTION 222.17, Florida Statutes.
I, Harker, Richard W. ~
. (please print your name clearly)
became a}aona fide resident of the State of Florida on october ,
2S $8 an3 I r~side at ~74~ I.~rk~'~c~ ~ri:re
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in the City of Ft. Pierce. FL 34951 .
My mailing address is: same .
(if different from street address? •
My former legal residence was in the City of North Cape May
,
State of New Jersey .
i (No further statement is required. However, if you wish, you may
j 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, ete.)
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I I FURTIIER CERTIFY that I will comply with all requirements
' of a legal resident of this State. I understand there is a
~ penalty. for perjury; perjury is a felony and is punishable by
incarceration in the State Department of Corrections.
Richard W. Harker ~ ~
i PRINT NAME SIGNATDRE ~
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~ PRINT NAME SIGNATURE
: Sworn to and subscribed befQre ~ue this 25 day of January ~
;
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DOUGLAS DIXON, CLERK OF CIRCUIT COURT
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BY ' i •f, 1~ ^ J
. Deputy Clerk ~ ~ ~ ~ -..,~,v : ~~f .
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P2oTAF;Y °L'~:.I~, Sta~2 _of ~ `
t~;3'.^ ST~TE rF fLO~!DA
MY COMMISSION EXPIRES:s:. f.` •s Er.~. C~~.t3,t~;3
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