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Y';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 r~ C' , that I am filing
this day in accordance and~in conformity with Section f~ , For da
Statutes.
FOR ~MICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~S~ ~ ~ F' T P ~ff/1S!_
_ s ree an n er
j S I ~ ~ = in ST. 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
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 /5~13L ~D U9N~= . ;
street an n r
~~j/, ~C GJG'/%" in GAG/~ County, Florida. I formerly resided at
~s ~ cit
' l /~-Cl/~l~ County, _ O,(/~J , 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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f~o/Rwd ~ RTRiciA A~
Sworn to and subscribed before me this /3 day of ~a.~. A. D. 19 ~ .
.
ROGER PO I TRAS, CLERK G IRGU I T COURT
ST. LUCIE COUNTY, FLORIDA
xotary Pu lic State o Flori a at Large. n
My Commission expires BY ~u.~~, ~/f~u~ DEPUTY CLERK
j FOR DOMICILIARIES OF STATES OTHER THAN TAE STATE OF FLORIDA:
~ I ere y dec are t at my omici 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,
and county of place of abode in Florida.).
(Person making declaration may also include such other and furCher 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.)
48~44~
i9 ~0 c~nY ! 3 AN i 1= 06
fflEO sN6 f£C8wE9
SLLUCIECOilll Y.FIlA.
ROrsER RwS
CLEnK CUIgA COURT
. PE 6t'.9 ~'fR!~QO__
x
signature
sworn to and subscribed before me this day of A. D. 19
f
`rotary Pub is State o Florida at Large. ~
ply Commission expires
~ I)11 ~
BOOK JJ~ PAGE ~ . ~
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