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491502
• DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller) ST. L UCIE County, Florida.
This is.n+ declaration of domicile in the State of ~
y , that I am filing
this day in accordance and in conformity with Section , or a Statutes.
FOR ~OMICILL#RIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~E f/P F ~ ,
s ree . an n er
„J\ . s P c~ in ST. LUG I E County, Florida, which place of• abode I
~1 Y
recognize and intend to maintain as my penaanent 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 permanently as such. I am, at the tiige of m inq this c}ara-
tion, a bona fide resident of the State of Florida residing at ~,/F~ ~ .P~F~ cf ,
• street an nu er
in ~ _if _ County, Florida. I formerly resided at
cit -
County, D a , and the
city state
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.)
~~OUNry
• ~ ~~co~
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v y ~
F
f
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~OPC
~'E cuwR'+ ~E signature
aR~ L . ~ 7T S
Sworn to and subscribed before me this day of , A. D. 1
•
OGER POI TRAS, CLERK G IRGUI T GOURT
ST LUG 1 E COUNTY, FLORIDA
Notary Pu he State o F on a at Large.
My Commission expires BY E P U T Y G L E R K
~ FOR DOMiICILLARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
f
er y ec are at my omici a is in the State of and that I intend
t 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 Irly 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 domicile within the State of Florida.):
I
491502
1960 JtA - I PN i= SB
"Leo ono ~ECOIIk o
~ stLVelE cow+tY~ku..
ROGER POITRAS
• CLERK CIRCUIT C8UR1~_
RFL6?,~ ~'FiiIF'f9
signature
Sworn to and subscribed before me this day of A. D. 19
6
a
~ Notary is State o F on a at Large.
My Commission expires
e~ 334 ~A~E 4~'9
_