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483813
~b~LARATION OF DOMICILE
To the Clerk of the Circuit Court County Coaaptroller) ST. L UGIE County, Florida.
This is my declaration of domicile in the State of that I am filing
this day in accordance and in conformity with Section on a tatutes.
FOR DEAoIICILIARIES OF THE STATE OF FLORIDA: C~c F•<< , • 1 - ~ ~ y
q9~o ~v~ o~~q~ ~s1~d i.
z hereby declare that I reside in and maintain a place of abode at
s ree an n er
-Jc'rt 5e,.c C~t'~ C !c, , in $T. LUC i E County, Florida, which place of abode I
c~ y
recognize and intend to maintain as my permanent home and, if I maintai'~ 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 ti~ of making this declara-
tion, a bona fide resident of the State of Florida residing at ~ 4.icc.~ . •
street an n r
in County, Florida. I formerly resided at
c ty ~
~ ~c~4?tooc ti. , Nc. Vn.c~~ County, ~ • , and the L
ci y state
place or places where I maintain another or other place or places of abode areas follows:
(Here list street address, city, county and state of any other place or places of abode.)
.
J~. ~ -
• ~ •
signature
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Sworn to and subs~`ri'b+~d before me this ~ ~ day of ~ati~-~ A. D. 19
ROGER PO 1 TRAS, CLERK G IRGU I T COURT
ST. LUGIE COUNTY, FLORIDA
Notary Pu 1c State o F on a at Large.
My Commission expires BY ~c~ DE PUT Y C L E R K
'I
FOR DOMZCILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
ere y ec are t at my~ omici a is n the State of and that I intend .
to permanently continue and maintain my domicile in suc state. At t e time of making 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 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 not to be
construed as evidencing any intention to establish his domicile within the State of Florida.)
~ 483813
19~A APR 2 ~ f
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~ `~MW~, r\ LUST
signature
_ '
~ ~s:orn to and subscribed before me this day of A. D. 19
~;otary Pu is State o Flori a at Large.
=y Commission expires
BfIOK J~?J Y~GE 2~4V