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DECLARATION OF DOMICILE
STATE OF FLORIOA
COUNTY OF ST. LUCIE
This is my Declaration of Domicile in the State of Florida
that I am filing this day'i~ accordance and in conformity with
SECTION 222.17, Florida Statutes.
I, (i~) Morales, Jose 6 Vivian ,
~ ~please print your name clearly) September 1978 (.Tose)
became a bona fide resident of the State of Florida on lanuary 1969 (Vivian)
19 and I reside at ~09 prautnn r.r ,
in the City of Ft Pierce, Fl 34950 .
My mailing address is: P 0 BX 2654 ' .
(if different from street address)
My former legal residence was in the City of Ms on~ Ind ana (Viyian)
State of Sta Ma Del Rio. SLP, Mexicq (Jose)
! (No further statement is required. eowever, if you wish, you may
` insert any pertinent facts such as sale of property or business
~ or relinquishment of employment at former dowicile, removal of
family to new domicile, purchase of home, etc. ~_2 A9 ~~5
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I FURTHER CERTIFY that I will comply with all requirements
of a_legal resident of this State. I underst~nd there is a
penalty. for perjury; perjury is a felony and is punishable by
incarceration in the State Department of Corrections.
Jose Morales ~ ~.~iL
PRINT NAME SI NATORE ~
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, Vivian Morales ' , 1`_~ ~ ~ ~('~~„~,~~~,0
PRINT NAME SIGNATURE
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€ Sworn ta and subscribed before me this ~ day of _ia,,,,A,.~ ,
1990 .
DOUGLAS DIXON, CLERK OF CIRCUIT COURT
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BY : ~ ,uitii:tiit~t~ `ti- : .
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Deputy Clerk ~ Y`:~~' ~
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NOTARY PUBLIC, ~tate o¢ riorida ' ~
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1l~:TARY ?l'8! IC STrTE CF FLf1RIDA t~•.,' ~
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MY COMMISSION EXPIRES:~' ~~~fi~`'^`" ~ - `
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