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484151
' • ~b~LARATION OF DOMICILE .
To the Clerk of the Circuit Court (County Cotraptroller) ST. LUC I E County, Florida.
This is mY declaration of domicile in the State of ~ , that Z am filing
this day in accordance and in conformity with. Section , or a tatutes.
FOR DE~IICILIARIES OF THE STATE OF FLORIDA:
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I her by declare that I reside in and maintain a place of abode at 1
• s ree an r
in ST. LUGIE County, Florida, which place o abode I '
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recognize'and intend to maintain as my permanent hone 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 ime m cinq th s declara-
tion, a bona fide resident of the State of Florida residing at ~o~
® ~ s rest an nu er
in, County, Florid:}. I formerly resided at
c Y ~ ~
~t County, and the
c y s e
place or places where I maintain another or other place or place of abode are as follows: j
(xere list street address, city, county and state of any other place or places of abode.)
I HAVE SEEN A RESIDENT SINCE-DEC. 4, 1979
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signature r ~r ~ Z
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Sworn to and subscribed before "me this day of , A. D: .I~~:• _
RO P01 TRAS, CLERK .C~~F~VY'~;'~~tT
ST. LUG 1 E COUNTY, OR t DA _
Notary is State o F on a at Large.
:2y Commission expires B DE P U T Y G l E R K
FOR DOMICILIARIES OF_ STATES OTHER THAN THE STATE OF RI
er y ec are t at my am ci e s 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.)
484151
• 1980 APR 23 Phi 2~ 09
iitEB ANa ~ECUTt~i t7
ST.LUCIE Cpp~~iY.flA.
ROGER POITRAS
BLERiI CIRCUIT
RCCORD Vf
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signature '
sworn to and subscribed before me this day of A. D. 19
`rotary P is State o For a at Large. '
'~y Commission expires •
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.