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DECLARATION OF DOMICII.~~ T~ s-••.~..~„_~ ~y <~~`urt
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STATE OE' FLORIDA i~"~..~.~. ~e~°U' Cle~k
COUNTY OF ST. LUCIE
This is my Declaration of Domicile in the 5tate of Florida
that I am filing this day in accordance and in conformity with
SECTION 222.17, Florida Statutes.
I~ ~ We ~ Nicholas, St Merite i
(please_print your name clearly>
became a bona fide resident of the State of Florida on August 1 ,
19 8G and I reside a~. ~&~3 Snannon Dr ,
in the City of Ft Pierce, Fl 34982 .
My mailang address is: Same -
(if different fro~ street address) •
My former legal residence was in the City of Port of Prince ,
' State of Haiti '
(No further statement is required. 8owever, if you wish, you may
~ insert any pertinent facts such as sale of property or business ~
or relinquishment of employment at fortner domicile, removal of
~ family to new domicile, purchase of home, etc
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1023031
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S1. LU~.!! :,~~t~ Y. >
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I FURTBER CERTIFY that I will comply k?ith all requirements
of a legal resident of this State. I understand there is a
penalty. for perjury; per~ury is a felony and is punishable by
incarceration in the State Department of Corrections. ~
St Merite Nicholas t/)')d n~; b~ Nt L~
PRINT NAME ~SIGNATORE ~
PRINT NAME SIGNATURE
~ Sworn to and subscribed before me this day of ,Tanuarx ,
19 90 .
DOUGLAS DIXON, CLERK OF CIFtCUIT COURT ,,_.y~s.~:_,,.,;,'.° j~~-
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BY : ;
~~`'`'~'rt'~~r `t+,; • ~ , •
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R , ~Yt_ J~_` ~K _ :e
Deputy Clerk ~ o ;1.~~=.• r,~d
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~t/'lT1TV ! "i L `•'4~~~-~~ ~~~f• ~
,..,.hn~ FLBLZC, Sta~~ ~i rlorida .r••..`~r~~~~~'
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t10TARY P(SBLIC STATE QF FLCN2IDA ~~4`+~""~•~t,
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MY COMMISSION EXPIRES ~r C~~tssirn ExP. CCT 19y3 ~
~ NS. GFtO. - .
eoo~ 675 PAGE~~eX7
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