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• ~~;flECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller) ST. L UCIE County, Florida.
This is my declaration of domicile in the State of F that I am filing
this day in accordance and in conformity with Section , F oricla 3`tatutes.
FOR D~MICILIARIES OF THE STATE OF FLORIDA: f
z hereby declare that I reside in and maintain a place of abode at L2C7~ ~~Yl~ IC;~:V AVc'1~Ue
_ street an nu er
7Yk p l ° rC e in Sj. LUC I E County, Florida, which place of abode I
ci y
recognize and intend to maintain as my permanent home and, if i maintain another place~or k
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 tune of making this declara-
tion, a~ bona fide resident of the State of Florida residing at 1
)nq «P_YZ~"~1C; nyenVe ) (
_~-street an n er
~ P? ers in St, L UC l ~ County, Florida. I formerly resided at
~=1nY i~a
~'>Y -ti' ~%1P_Y^_ . - Wit. ~Ur tf
; County, and the
~~~~city state
place or places where I maintain another or other place or places of abode are as follows:
(Here 13st street address, city, county and state of any other place or places of abode.)
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Sworn to and subscribed before me this day of A. D. 19 a ~
ROGER 1 TRAS, CLERK CIRCUIT COURT
ST. LUC I E CO TY, FLORIDA
'rotary Pu is State o F orida at Large.
~ My Commission expires 8Y C~ .DEPUTY CLERK
I FOR DOMICILIARIES OF STATES OTHER THAN TAE STATE OF FLORIDA:
f I ere y declare t at my omic~le is in the State of and that I intend
` to permanently continue and maintain my domicile in suc state. At the 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.)
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signature
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worn to and subscribed before me this day of A. D. 19
`rotary Pub is State o Flori a at Large.
'~!y Commission expires
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