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45381
~•:flECLARATION OF DOMICILE
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To the Clerk of the Circuit Court [County Comptroller) ST. l UCIE County, Florida.
This i8 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.
1
FOR I~MICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at_ ~ D (,t~1~'
- stree an n er
1 , in ST, L UCIE County, Florida, which place of abode I ~
city '
recognize and intend to maintain as my permanent home and, if I maintain another pla~ce-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 haae,
and I intend to continue it permanently as such. I am, at the time of mak' q this s~lara-
tion, a bona fide resident of the State of Florida residing at ~ D ~ t/_ _ _!?f~l,~ ~
' street an n m r'r'
~ 7 ~in jSy-. ti. ~ ~ ~ County, Florida. I formerly resided at
1 _ . c ty _ ~ ~ ~
( ~ . ~ ~ Y~ ~ (3 County. 1~ , and. the
ci Y st te•
place or places where I maintain another or other place oX places of abode are as follows;
txere list street address, city, county and state of any other place or places of abode.)
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signature
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Scorn to and subscribed before me this ~ day of ~ , A. D. 29 a
ROGER PO I TRA S, CLERK G I RCU I T DOUR T
ST. LUC I E C UNTY, FLORIDA
`rotary Public State of Florida at Large.
My Commission expires BY DEPUTY CLERK
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
I eie y dec are t at my omicile 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.)
~ t~~Y -5 PMi 12~ 51
f ED PESO~
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5~017RASA
CLERK C~RWiT CQtlR
_ PEtARA Y~RtF~[C _ - ~
4~5381 signature ~
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sworn to and subscribed before me this day of A. D. 19
`+otary Pub is State o Flori a at Large.
~.y Commission expires