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DECLARATION OF DOMICILE ~
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To the Clerk of the Circuit Court [County Comptroller] ST. LUC I E County, Florida.
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This is my declaration of domicile in the State of fJ` , that I am filing
this day in accordance and in conformity with Section , or da
Statutes.
FOR~bOMICILIARIES OF THE STATE OF FLORIDA:
i hereby declare that I reside in and maintain a place of abode at ,Q?S0~ /YEWp01tT 17/Z.
stree an n er
~rPj~'R CE in ST. LUC I E County, Florida, which place of abode I
c ty
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 hare,
- and I intend to continue it permanently as such. I am, at the time of making thi,~ declara-
tion, a bona fide resident of the State of Florida residing at ~„S 0~ n/EwPo1t /
_ ~ treet an n~e'~-
nl~,~CC-+ in S/ V C/ G= County, Florida. I formerly resided at
A c t s) ~w R ~ Sa.? County, /V • ~ and the
city sate
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.)
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C~r/ 1f•' v0~~isti
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~l(/I'~Li Jo hNSoN~
Sworn .en$;,subscribed before me this day of , A. D. 19~G .
tia'`'Zdt.,M ER P01 TRA S, CLERK CIRCUIT COURT
-`a•'r~~".~•'~,,-- o°' ST. LUCIE COUNTY, FLORIDA
No ~.-ic o F on a at Large.
My.:- ~ ssiofr, ex~}~es DEPUTY GIERK
~ _ CILZAB~~ QF STATES OTHER THAN THE STATE
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at my omicile is n the State of and that Z intend
to. t4 ~~ntinue and maintain my domicile in suc state. At the time of making-this
dec~aa~{it$oa:~ti~ ~ a bona fide resident of the State of My place of
abode~~`ifthiif the State of Florida, if any, is as follows: Here st street address, city,
E 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.)
{ 496860
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1980 JU?a 25 t~ 2 41 .
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signature
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Sworn to and subscribed before me this day of , A. D. 19
Notary P is State o F on a at Large.
My Commission expires
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