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•'tecFee! -~-..~-,OOUGLAG nI~ON
Add Fce s SL Lucie
Lbc '1`u i._...__~ Clerk of u~{
IAt Tax S By - ~ ~
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DECLARATION OF DOMICILE ;
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STATE OF FLORIDA '
COUNTY OF ST. LUCIE
7Chis 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, E'lorida Statutes.
I, t We ) Myers, William E~ Gloria S ~
(please print your name clearly~
becarae a bona f ide resident of the State of Florida on .~une ,
19~_ and I reside aL :i02 west Arbor Av ,
in the City of Port St Lucie, Fl 34952 .
My :nailing ac~dress is: Same • . '
(if different from street address) ~
My former legal residence was in the City of Emporia , ~
State of ~A • ~
4 tNo 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.)
~0 FEB -2 A 9 :17
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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
t penalty. for perjury; perjury is a felony and is punishable by
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incarceration in the State Department of Corrections.
William E Myers 1 ~
E PRINT NAME SIGNATURE
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Gloria S Myers r ~y~~~,t~
PRINT NAME ~IGNATURE~ U
, Sworn to and subscribed before me this day of .Tanuarv .
19 90 .
DOUGLAS DIXON, CLERK OF CIRCUIT COURT ,~~j-';+•~-:`,`.!;.""~:~,
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BY : ; y _ ~ ~~1~'~~: %
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Deputy Clerk ~r~ ~~t~'~~~~~nnn +
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Flprtcia ' .~,:v=,Q_'~~~
NOTARY PUE3LiC, State or , ~fhi,~, ,?~4=,
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P?;TrcY PilBtIC STATE OF Fi.ORIDA
MY COMI~IISSION EXPZRES!'Y r.xP. GC7.13~1~9/~93
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800K67~ PACE~~eh7
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