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: ri~ : DECLARATION OF DOMICILE 4;~p
To the Clerk of the Circuit Court ICounty Comptrollers ST. L UGIE County, Flozida.
This is my declaration of domicile in the State of r
~ OR~~~__ that I am filing
this day in accordance and in conformity with Section ~3'F:I
~~Io~r ~$tatutes.
FOR ~0l~IICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at 307/I NE~~/gvQv ,
s ree an n r
~iE/~'Ct , in ST. LUC I E County, Florida, which place of abode I
ci y ~
recognize and intend to maintain as my pern?anent 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 hare,
- and I intend to car~inue it permanently as such. Z am, at the time of akinq this declara-
tion, a bona fide resident of the State of Florida residing at FR//9~tldd
street an n r
^j
f i~ ~F , in ~5~~ ~Ut2i~ County, Florida. I formerly resided at
ty ~
D v~J ~ J E"-~-~~7~ty ~ County, /~E
,ytr/ck t~ and the
c ty state -7-'-
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.)
.~i s;
•'a ~j~i.
sigma ure : :rs''K..~~`~'
Sworn to and subscribed before me this ~ day of , A. D. 19 0 d.
GER P01 TRA S, CLERK G I RGU 1 T COURT
S UGIE COUNTY, FLORIDA
Notary Pu is State o F on a at Large.
My Cattmission expires BY DEPUTY CLERK
FOR DOMICILZARIES OF STATES OTHER THAN TAE STATE OF
t
ere y ec are t at my omz.ci a is 1n 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 A!y 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.)
I
(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 danicile within the State of Florida.)
4902
X80 .~lti 19 ~ P!I 3 17
~ S RE POITR
g~' V ,
- CLERK CIRCUIT COtHtT t~
RECORR VfRlt•tE4
signature
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sworn to and subscribed before me this day of , A. D. 19 _
r7otary Pub is State o F on a at Large.
My Commission expires
.