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4848131
- ~b~LARATION OF DOMICILE ;
To the Clerk of the-Circuit Court [County Camptroller~ ST. L UCIE County, Florida.
This is my declaration of domicile in the State of ~foQl~,,,, that I am filing
this day in accordance and in conformity with. Section I~o~cTa-3`tatutes.
FOR DEA~fICILIARIES OF THE STATE OF FLORIDA: ~
I hereby declare that I reside in and maintain a place of abode at ~ C~ 7 ,
in ST. LUIrIE County, Florida, whichrplace ofnabode I
c y
recognize and intend to maintain as ny 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 tii~~e of al~.tng thi~declara- ~
tion, a bona fide resident of the State of Florida residing at _~l2Q 5 • 4 ~r''~`---- ,
street an n er
c t ~ in ,S-f ~ ~ e ~ E% County, Florida. I fob-resided at
3e ~ ~ rcty e n County, n ~ , and the
c~tyj sae -
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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V Una . c_,-1' F o r d) -
- signature
j~~~~t~l~zurrFrcrr:,,,
Q ti (Y08;
Sworn to and subscribed before me this ~ 1 day of ~ r~ , A. D.`~
. 'i .f - a . .
ROGER P01 TRA S, CL _ .:T
~ ST. LUC 1 E COUNTY - ~`•~i, ~
Notary Pu c State o F or1 a at Large. ~ ' - ~ ~
My Commission expires 8Y - ~1FRK
, i
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE O - ~
ere y ec are t at my c e 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.)
X84881
- 1980 APR 29 P~ ~ 48
FIlEO ARC ~E ~
3 ROGER
~Ot ~i/~S~A-
~ERK CIRgHT COON~r~
s~VLtt~F;E~..._.4~!~~1----~-- -
signature '
sworn to and subscribed before me this day of A. D. 19
*~otary Pu is State o For a at Large.
~y Commission expires
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8339 p,~~
197 ~ f