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X83463 ~
• : ~ j~b~LARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller) ST. LUC1E County, Florida.
7chis is my declaration of domicile in the State of ,y , that I am filing
this day in accordance and in conformity with.Sectiotr" , or da
statutes.
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FOR D~CILIARIES OF THE STATE OF FLORIDA: I
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I hereby declare that I reside in and maintain a place of abode at ~?~Q. 3 f~,~ y~~9 ,
• s ree an nu~err
P , fn ST. LUC 1 E County, Florida, which place of abode i
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recognize and intend to maintain as my permanent home and, if I maintain another place•or
places of abode in same 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 time of making this declara-
tion,~ a bona fide resident of the State of Florida residing at iQ. ~3 /jam y 9 ,
~ ~ - street ancT n r -
• ~ in County, Florida. I formerly resided at
T - c. tY ~
/i" ~ ~ =2 Q ~ - , _v . _ County . ~ii-u~Cc-~~~ . and the
city . -~sta e '
place or-places where I maintain 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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~~~.Qs signature
Sworn to and subscribed before me this day of , A. D. 19
ROGER PO I TRAS, CLERK CIRCUIT COURT
ST. LUCIE COUNTY, FLORIDA 1
Notary Pu is-State o F on a at Large.
My Commission •expires BY~nc~c DEPUTY C L E R K
FOR DOMICILIARIES OF STATES OTHER THAN TAE STATE OF FLORIDA:
ere y ec are t at my omici a is in the State of and that I intend
to permanently continue-and maintain my domicile in suc state. At t e time of makiRq this
declaration I am a bona fide resident of the State of My place of
abode within the State of Florida, if any, is as follows: Here 1st 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 not to be
construed as evidencing any intention to establish his domicile within the State of Florida.)
483463-
•1980 APR 18 AK 09
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~;,WtQIE COONfY.iIA.
tRU6ER t01TRAS
~Ri(.CIRCUt7 60U T - .
;~pD~V[#ff ~EO_
signature
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Sworn to and subscribed before me this day of , A. D. 19
.
Notary P is State o F on a at Large.
My Commission expires '
. e~x329 P~cE~.$57~ -
.