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X89853
' DECLARATION OF DOMICILE
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ST LUC I E
To the Clerk of the Circuit Court [County Camptrollerj County, Florida. ~
This is my declaration of domicile in the State of 6L/
this da in accordance and in confonait with Section that I am filing ~
Y Y , or a tatutes.
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FOR~OMICILIARIES OF THE S~ATB OF FLORIDA: - QQ~~// pp
t hereby declare that I reside in and maintain a place of- abode at e./7y~ ~ /L
A~~ ~ ~Q s r e~
an n er ~
_~~ity)~ , in ST. LUG I E County, Florida, which place of abode I
city) i
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 i
residence and abode in the State of Florida constitutes my predominant and principal home, 4
_ -and I intend to continue it permanently as such. I am, at the time akin thi,~ declara-
tion, a bona fide resident of the State of Florida residing at ~~D
7 /~C.~ , s'
street an n er
~f~CQ~ , in 4 S~ ~-IG~C.1L~., County, Florida. I formerly resided at
ty ~
- County, , and the
city s ate - -
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.) E
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Sworn to and subscribed before me this ~ day of L , A. D. 19~C~
R ER POI TRAS, CLERK G IRCUI T COURT
ST. LUC I E .COUNTY, FLORIDA
Notary Pu he State o F on a at Large. ^ J~
~ My Commission expires BY ~ ~~:ut.CC?~ DE P U T Y C L E R K
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FOR DOMICILIARIES OF STATES OTHER THAN TAE STATE OF FLORIDA:
ere y ec are t at my omic a sin the State of Gt;f 2.~ and that I intend ;
~ to permanently continue and maintain my domicile in suc st te. At t e time of making this
i 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:-n Here ist street address, citg,
and county of place of abode fn 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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signature
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Sworn to and subscribed before me this ~iay of , A. D. 19
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Notary P 1.c State o F on a at Large.
My Commission expires
8~t1X~J PJ?fiE X451
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