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. TI~ : DECLARATION OF DOMICILE ~ '
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 ~~G'/~Il~f~ , that I am filing
this day in accordance and in conformity with Section ~'~'~I orida ~'tatutes.
FOR~OMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ZG~t ~Q/V ~.G N
_ is ree an n er
~L"/PG~ 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,
end I intend to continue it permanently as such. I am, at the time of making this d clara-
tion, a bona fide resident of the State of Florida residing at , s
~ ~ street an n r
~ ~~%G/QC~ in s~ ~ G~ G / L County, Florida. I formerly resided at
city ~
S/ e, . " i (,~L C NS County, ~ and the
city st to
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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Sworn toa •aad~ subscribed before me this ~ day of A. D. 19 a . s
{
~ ROGER PO I TRA S, CLERK CIRCUIT COURT
~ LUC I E COUNTY, FL I DA
Notary Pu he State o F orida at Large.
My Commission expires ~ DEPUTY C L E R K
i
t FOR DOMICILIARIES OF STATES OTHER THAN THE STATE FLORID .
i -
~ ere y ec 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 further facts with reference to
any acts done or performed bysuch person which such person desires or intends not to be
construed as evidencing any intention to establish his domicile within the State of Florida.)
19$0 JUN -5 PN I~ 27>
F LEQ ANC R'C~?R~ED ~ '
S , i1CiE ~Y flA.
~OGER POITRAS `
CLERK CiRCU1T CAURT
._-_1.-
R~Gtt?D 1!ER!F!g0.-
- 4
~~~?7!~~ signature
Sworn to and subscribed before me this day of A. D. 19
'rotary Pub is State o F on a at Large.
*iy Commission expires
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