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48'7415
' - ` i=DECLARATION OF DOMYCILB ~
To the Clerk of the Circuit Court [County Comptroller) ST. LUC I E 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.
FOR~O!lICILIARIES OF TBE STATB OF FLORIDA:
i hereby declare that I reside in and maintain a place ~of abode at ?O(~ !r [/S ~ / ,
- s ee an n r
prnti ~T. ~ , in ST. LUG I E County, Florida, which places of abode I
Tc~ 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. home,
- ~d Y intend to con~;Lnue it permanently as such. I am, at the time of makin this deZ`lara-
tion, a bona fide resident of the State of Florida residing at 2G 300 _ U5' 'ic`y / , ~
~ s r@et an n~II1u @2'j
/~it~ ~ • i~u•c~R in/,l,T zinc-c.,~ County, Florida. I formerly resided at
cat ~
r~T ;lc~t,~.t County, ~~=oho. , and the
c ty sta e - -
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.)
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s' - rl' ''vt J
Sworn to and subscri~e~``before me this as da of ~
y Ct^iy , A. D. 19 ~0 .
ROGER P01 TRAS, CLERK C IRGUI T GOURT
ST. LUCIE COUNTY FLORIDA
s
Notary is State o For a at Large.
f My Commission expires BY ~/Gtt~~ DEPUTY C L E R K
p FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA: -
er y ec are at my c e s the State of and that I intend-
to permanently continue and maintain my domicile in suc state. At a time of making this
declaration Z 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.)-
~~3'7415
190 hAY 22 PM 12~ 07
f itl0 ~ COhik U
S
806E AAS~.
CLERK CIRCt11T C8ilRT
pLG~R VERIFIF'C_, ~ signature
Sworn to and subscribed before me this day of A. D. 19
Notary P c State o For at Large.
*iy Commission expires .
• - g~33~. P,~~3~7
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