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4133303
• ~b~LARATION OF DOMICILE
'ro the Clerk of the Circuit Court [County Comptroller] ST. L UC1E County, Florida.
I1
This is my declaration of domicile in the State of D ~ : C~Gt..~ that I am filing
this day in accordance and in conformity with Section ~~fTT;- arida 3`tatutes.
FOR D~I'ICILIARIES OF THE STATE OF FLORIDA: / /
z hereby declare that I reside in and maintain a place of abode at ~ ~~cy 0 DAL ~ce
^ ~ in ST. LUG I E County, Florida, whichrplace of abode I
ci y
recognize and intend to maintain as my. permanent home and, if I maintain another place•or
places of abode in some other state or states, I hereby declare that my above-described
residence and abode in the State of Florida constitutes my predominant and principal home,
and I intend to continue it permanently as such. I am, at the t e ~ akinq this declara-
tion, a bona fide resident of the State of Florida residing at LciO D a ,
, s*reet an nw r '
in ~ja , L L, c C County, Florida. I formerly resided at
city ~
E o ~6~ f ~ ; County, , p , and the-
city state
place or places where i mmaintain another or other place or places of abode are as follows:
(Here list street address,~city, county and state of any other place or places of abode.)
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~=4~ c~.~ Nry
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a4 signature
"f• ~s: Q\ R (4 ~OIIRN
sworn to and subscribed before me this l7 day of ~ . A. D. 19 80
ROGER P01 TRA S, GL ERK G i RGU 1 T GOUR T .
ST. LUG I E COUNTY, f'LOR I DA
notary is State o F on a at Large.
My Commission expires B Y ~~d~ DEPUTY CLERK 1
FOR DOIrlICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
er y ec are t at my om c e is the State of and that I intend
to permanently continue and maintain my domicile in suc state. At t e time of making this
3eclaration I am a bona fide iesident of the State of Ny place of
abode within•the State of Florida, if any, is as follows: ere ist street address, city,
and county of place of abode in Florida.)
(Person making declaration may also include such other and further facts with reference to
any acts done or performed by such person which such person desires or intends riot to be
construed as evidencing any intention to establish his domicile within the State of Florida.)
413.3303
-1980 APR 17 AK 50 ,
FilEO ANC ht C~ftUi U
ST. IUCtE COtN t Y. F t A.
ROGER POITRAS
lLERK CFRCUIT COURT '
AtCNRb VERIf tELt_ _ .
signature '
Sworn to and subscribed before me this day of , A. D. 19
i
Notary P is State o F on a at Large. ~ 1
My Commission expires
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