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' n~~:DECLARATION OF DOMICILE
To the Clerk of the Circuit Court (County Caaptrollerl ST. L UCIE County, Florida.
This is my declaration of domicile in the State of ~ ~pf`l~} , that I am filing
this day in accordance and in conformity with Section on a tatutes.
FOR ~'IOMICILZARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~ ~ 7 ,
/U ~ L uc~~ . in ST. LUC I E County, Florida, whichrplace ofnabode 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,
_ -and I intend to continue it penaanently as such. I am, at the time making this declara-
tion, a bona fide resident of the State of Florida residing at /Q/~ ~ , •
-mss reet an n r'S'-
in County, Florida. I formerly resided at
_ c t
`i"y /r~ I^!
I c1l . ~ s S~ G(- county. F!v ~ a r~ and the
city sta e
place or places where I maintain another or other place or places of abode are as follows:
(Here 3ist street address, city, county and state of any other place or places of abode.)-
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Sworn to and subscribed before me this day of - , A. D. 19 ~ i
I
. ROGER PO i TRA S, CLERK C I RCU I T COURT
ST. LUCIE COUNTY, FLORIDA
Notary Pu 1c State o F on a at Large.
My Commission expires BY~_ DE P UT Y G L E R K~
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA: .
I
er y ec are t at my omic a is n 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: ~ ere 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.)
190 ,NN I S P!I 2~ 43
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~ ROG~ POtTRAS
} CLERK CIRCUIT C T
RECORB ~'ERiF1E0
s 490153
signature _
sworn to and subscribed before me this day of , A. D. 19
notary Pu is State o For a at Large.
'~y Commission expires
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