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' ~ :~ZI~ DECLARATION 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 , or a tatutes.
FOR~OMICILURIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at i~l.~~/AlG9CSMiPL ~ ,
/~RT Sy: ICvc.~ in ST. LUC I E County, Florida, whichrplace ofnabode I
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recognize and intend to maintain as my permanent home and, if I maintain another place•or
places of abode in soave 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 con#~nue it permanently as such. I am, at the time of maki~ this declara-
tion, a bona fide resident of the State of Florida residing at1 V~ ~ , s
s ree
Po~tj' ~la4t,~ in sr Itt/~//~ County, Florida. I formerly resided at
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/°i R T ~llyy~itDA~E' . • 8Ra Idgrea County, ~ O / /y and the
c ty state
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.)
/1!o N A~'
J
s gnature
Swor t~: ~d ~b's~d before me this J ~ ~ day of N , A. D. 19~.
a ~ 'F ~ ~ ~ y
ROGER P01 TRAS, CLERK CIRCUIT COURT
ST. LUG I E COUNTY, FLOR 1 DA
N c a ey ~ on a at j,g~e.
~ ply Co(q~ AtE OT iWttO? AT ll~~
BY DEPUTY CLERK
~
F'OR DOMICI ~ THE STATE OF FLORIDAA:
't
ere y ec are at my oauc a is 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 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.)
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POITRAS
CIRCWT C9~q~T _
_ IR•CQR~ VERIffEEi ~
signature
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sworn to and subscribed before aae this day of A. D. 19
r~otar P is State o F on a at Lar e.
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?~y Commission expires
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