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485 ~ ~
35'7
' TI~ ;flECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptrollers 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 F on a tatutes.
FOR I~MICILIARIES OF TAE STATE OF FLORIDA:
t hereby declare that I reside in and maintain a place of abode at ~ ~ja ~j,
_ r_ - Q C _ ~ - in s •re'~an~n er
GGt I"' J ST. LUC 1 E County, Florida, which place of abode I
city
recognize 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 home,
and I intend to continue it permanently as such. I am, at the time of makin this declara-
tion, a bona fide resident of the State of Florida residing at ~ )
S_ 3 3 5~f Z' , in S7` • c.~.-L Count ,Florida. street an n r
`7city y I formerly resided at
~ L~.2~ . County, L•~ , and the
ci y~ state 'S" 1
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.)
,tta~<<~/ a ~ ~ 111;!!x.
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~+ryt~ Luc s~htt aF waia? ~ ~ ~
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' signature
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Sworn to~~and''subscribed before me this ~ da of
y , A. D. 19
ROG P01 TRA S, CLERK G I RCU I T COURT
ST. LUC I E _ COUNTY, FLOR 1 DA
`iota b is State o F on a at Large.
y Comm on expires _ ~ BY DEPUTY CLERK
FOR DOMICILIARIES OF STATES OTAER THAN TAE STATE OF FLORIDA:
7 ere y declare t at my omlcile 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.)
48535'7
' 1980 lIAY -5 IUI i~ 4
F~EOO ~?NC Ric o
ST.LUCIE CO~ tY.7LLA.
R06ER POITRAS
CLERK CIRCUR I~Y11T
REc~S vE~:F1fQ_ _
signature
i
sworn to and subscribed before me this day of A. D. 19
'+otary Pub is State o F on a at Large.
~'y Commission expires
80~1X~ PAGE~;V(..1