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4 X49'78
- ' • - ~b~LARATION OF DOMICILE
To the Clerk of the Circuit Court [County Caaptroller) ST. L UCIE 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 , or a tatutes. ~i
FOR DE1i~YCZLIARIES OF TAE STATE OF FLORIDA: ~
I hereby declare that I reside in and maintain a place of abode at~ ~ c/e~'-~.G~ ,
fs ree an n er
,fir , in ST. LUC I E 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
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 hone,
and I intend to continue it permanently as such. I am, at the time of maki this d~~}ara- ~
tion, a bona fide resident of the State of Florida residing at / •
street an num er
i
, in ~f /~G~~~ County, Florida. I formerly resided at
c t . ~Y~f'f...~h~L~~aG~! County, l~O~/~~~ and the
c ty ~ state -
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.)
_ ~
'k ~ ~ '
~1 ' -
s~-'-- " - ` signature
sworn to and subscribed` before me this 3 o day of Q~.~ , A. D. 19 g0 .
ROGER PO I TRA S, CLERK C I RCU i T LOUR T
- ST. LUC I E COUNTY, FLORIDA
Notary Pu is State o F on a at Large.
My Commission expires BY Qs~-~lh- ~y~~ DEPUTY CLERK C
~ FOR DOMICILIARIES OF STATES OTHER THAN TAE STATE OF FLORIDA:
~ ~ ere y ec are t at my omic 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 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,
i and county of place of abode in Florida.)
E
~ (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.)
• 1980 APR 30 PN i2~ 31 -
rILIlEO AhG 11ECOKt1f D ~
S R06ER
POITRa5A~
tIERK CIRCWt CO
RE03R~ YEptFIE1---_-_ -
signature '
E
' sworn to and subscribed before me this day of , A. D. 19
g
rTOtary P is State o F on a at Large.
~ My Commission expires
- nR pA6E~~~ -
CA7K .
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