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488859
' • 1I~ : DECLARATION OF DOMICILE '
To the Clerk of the Circuit Court [County Comptroller] ST. L UGIE 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~OMICILIARIES OF ~$E STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~i
Z~re an n er
- ~ j~,~~ , in ST. LUG I E County, Florida, which place of abode I
c y
recognize and intend to maintain as my penaanent 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 co~~.nue it permanently as such. I am, at the tim f maki thi cl a-
tion, a bona fide resident of the State of Florida residing at T3~~ ~ ~n,d(1Q ~
in ~~L~Q County, Florida. Itformerly resided at
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County, , and the ;
city 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 ^F abode.)
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Sworn to and subscribed before me this ~a day of , A'. D. 19 ~
ROGER P01 TRAS, CLERK CIRCUIT COURT
• ST. LUGIE COUNTY, FLORIDA
~:otary Pu 11c State o F on a at Large.
My Commission expires BY ,~_a, DEPUTY CLERK
FOR DOMICILIARIES OF STATES OTAER TAAN THE STATE OF FLORIDA:
i
ere y ec are t at my om cile 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: Hefe 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.)
• 438859
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Sworn to and subscribed before me this day of A. D. 19
clotary P is State o F or1 a at Large.
My Commission expires ,
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