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• ~ ZI~. DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Canptroller~ ST. L UCIE 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.
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FOR ~OMICILIARIES OF THE STATE OF FLORIDA: pp~~
I hereb declare that I reside in and maintain a place of abode at lN/ ~~/n'0 D~~''
Y
-Ts rest an n rT-
ORT ST ~UG /,E in ST. LUC I E County, Florida, which place of abode I
c ty
recognise and intend to maintain as my permanent have and, if I maintain another place•or
places of abode in sage other state or states, I hereby declare that my above-described
residence and abode in the State of Florida constitutes my predominant and principal hone,
- and I intend to continue ft permanently as such. I am, at the tim of cinq this decl~a-
tion, a bona fide resident of the State of Florida residing at ~9lYJ /N6 ,~EL /iS
~/2 S T' ~U ~ in ST County, Florida. Itformerly cesium
i ~ tY ~
~!/~J / Tt ~9 ~ f , - ~S T~'H~"sT~ County, / V ~ and the
city 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.)
::uiNltilf~j~~ ~ G~iC ~I~
_ , s.•~Gti, s°~ - signature
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Z .i ~ ~ ' +
t'o ~a s• - d before me this day of A. D. 19
~ r~N••M•'L~~~.~` - GER POI TRAS, GLERK G IRGUI T GOURT
C1'E" ti.~` T LUG i E COUNTY, LOR 1 DA .
Notary State o F on a at Large.
My Ca~i~sion expires B Y DE P U T V G l E R
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF RI
I
er y ec are t my ci a is in the State of and that I intend
I to permanently continue and maintain my domicile`in suc state. At a 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: Here 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 danicile within the State of Florida.)
49(J538
1980 JUN 23 A~: ?1~ 0 I
F~ED ANC PEtfi.'ti~t U
~ SROGER
POITRAS~•
CLERK CIRCUIT CC~RT
RECORt VfRtF'Ci?. -
signature
f
Sworn to and subscribed before me this day of A. D. 19
Notary is State o For a at Large.
My Camaission expires
a~333 p~1518 .
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