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~~:_DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller] ST. L UCIE County, Florida.
This is my declaration of domicile in the State of 021 , that I am filing
this day in accordance and in conformity with Section or a tatutes.
FOR •UOMICILIARIES OF THE •STATE OF FLORIDA: 6 °3
I hereby declare that I reside in and maintain a place of abode at 99y6 N~ 6CERN 81uD ,
s ree an n err
. in ST. LUCIE county, Florida, which place of abode I
c y
recognize and intend to maintain as my permanent home and, if I maintain another place•or
places of abode in sane 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 permanently as such. I am, at the t~e of making this declara-
tion, a bona fide resident of the State of Florida residing at S/o /~lE bC~Ant (~Lvfl ,
n street an n r
E t~N (~E/~ ~ in S~•- L u C / C County, Florida. I formerly resided at
c ty _ ~
~G/Cr/Dalyi c~ YN T N 612 . ' /.ll~ ff 1'w County, ate _ and the
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.)
(p4~t ~1~ y yt'twN Frrf7 ~ z ri c~e ~~j a ~ ~Lo yl /D A
J ~
- ` „s.~ siq ature
• _ "i
• x
Sworn to and sited before me this "2d day of - , A. D. 19~_Q.
~ GER PO I TRA S, CLERK C I RGU I T COURT
' : LUG i E COUN , FLOR I OA
Notary = 1 tote o F on a at Large.
II M Coamiis'sioii fires DEPUTY C L E R K
Y ~
FOR DOMICILZARIES OF STATES OTHER THAN THE STATE OF IDA:
ere y ec are t my oauci 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 fist 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.)
~9~~
X980 Jl1N 20 Pk 2 32
t~f AND FEC08D4 0
~ ~I COUNTY.Ft A.
(~ER!(CIRCUIT
COUR
QE60R~3 ~'FFIf ~
signature
Sworn to and subscribed before me this day of , A. D. 19
Notary P 1c State o F on a at Large.
My Caamission expires
i
B~JJJ P~GE~.~~