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4N4~y,~ ~ ~
~b~LARATION OF DOMICILE ~
To the Clerk of the Circuit Court [County Comptrollers ST. LUCIE County, Florida.
This is my declaration of domicile in the State of j~•A.~ 1,1.. J . that I am filing
this day in accordance and in conformity with. Section~"I'f~ !'I'~or~da'3~tatutes.
FOR DE>~I'ICILIARIES OF THE STATE OF FLORIDA( ~
I hereby declare that I reside fn and maintain a place of abode at 3 1p r'~.~i,.s~.~ s, L ,
Ts ree an n er
in _ ST. LUCIE County, Florida, which place of abode I
c y
recognise and intend to maintain as my permanent home and, if I maintain another place•or i
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 tdy predominant and principal home,
and I intend to continue it permanently as such. I am, at the tithe of mal q-this declara- i
tion, a bona fide resident of the State of Florida residing at L , ~
stree an n er
~ in ~ ~ County, Florida. I formerly resided at
.r
c y ~
~ta~ . (1~ . _ /L~J County, . - , and the t
cty sae - i
place or places where I maintain another or other place or places of abode are as followss
(Here list street address, city, county and state of any other place or places of abode.)
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s gnature
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Sworn to and subscribed before me this ~ day of , A. Dt'~~ _ ~'j
. R0 PO I TRA S, C~~Rl4''C't : 1 T~ GQtd~T `
T. LUC I E COUNTY, - _ ; -
Notary c State o F on a at Large. ~ . ~
My Commmission expires • ~ ~~~~VT Y.'C~L,~ R K
FOR DOMICILIARIES OF. STATES OTHER THAN THE STATE O ~/,;f~~~j,~K,+-~_~~~; r~~
ere ec are t t my omic e s the State of and that I intend
to permanently continue and maintain my domicile ins 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: ere ist street address, city,
and county of place of abode in Florida.) .
(Person making declaratiaq~t$ay.,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.)
4~~
1980 APR 29 PR 2: 18
f~~r:o ~rra r~cor~:Eo
SLLIiC1E COUNTY.fLA.
tLEq CIRC~T
tR'~Agst /J
a:care vERrfr:Z___~
signature '
sworn to and subscribed before me this day of A. D. 19
r7otary P c State o For a at Large. •
?~y Commission expires
lid
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