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DECLARATION OF DOMICILE Add F~~e = tir .
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STATE OE' FLORIDA h~
COUNTY OF ST. LUCIE ~ ~%~:~u~y c;let~
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Thxs 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~ ~ We ~ Davis, Lamonte W b Gloria M
~
(please print your name clearly)
became a bona fide resident of the State of Florida on November ,
2; an3 S r€:sid~ : t H105 Coauina A;~ .
in the City of Ft Pierce, Fl 34951 .
My mailing address is: Same • .
(if different from street address3
My former legal residence was in the City of Jackson ,
State of TN •
; (No 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. ~_2 A9 :j 7
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I FORTHER CERTIFI~ 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. ~
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Lamonte W Davis
PRINT NAME SIGNA RE ~
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Gloria M Davis ~ I
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PRINT NAME SIGNATURE
~ Sworn to and subscribed before me this 1 day of February ,
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DOUGLAS DIXONi CLERK OF CIRCUIT COURT .,,ae`.``."."t~?J~~~trr _-?J
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BY : r~,~ . . ~ ~
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Deputy Clerk
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NOTARY Pt3BLIC, State of Florida J.-:~: l~~~t?~~-'.'.
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1'r'3?ARY 1L•~~_IC S7.~Tf ~ FLdRIDA '
MY COMMISSION EXPIRFJS:~=::~~'~"'~`: E•~. 4~z.t3.1993 j,.
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