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~9165U
DECLARATION OF DOMICILE
To the Clerk of the Circuit Court (County Comptrollers ST. L UGIE County, Florida.
This is my declaration of domicile in the State of Florida that I am filing
this day in accordance and in conformity with. Section , or a tatutes.
FOR ~OMICILIARIES OF THB STATE OF FLORIDA:
1 hereby declare that I reside in and maintain a place of abode at 310 South 10th St.
s ree an n er
Ft. Pierce, , in ST. L UGIE County, Florida, which place of abode I
ci 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 tae of making this declara-
tion, a bona fide resident of the State of Florida residing at jiO South 10th St. ,
street an n r
Ft. Pierce, - in St. Lucie County, Florida. I formerly resided at
615 Linc 9~?ty ve. Portage. ~
County, Ohio and the
city -state I
place or places where I maintain another or other place or places of abode are as follows:
(xere list street address, city, county and state of any other place or places of abode.)
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.~,,3~. signature
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.1E~o to.~t~d:~su`bscribed before me this 1st day of ~~lY , A. D. 19 80
~Ir ri}.,
' ROGER POITRAS, CLERK GIRGUIT GOU2T
. ST. LUGIE COUNTY, FLORIOp
Notary c State o f i s at Large.
~ My Commission expires ~~-:?ar82 B Y DEPUTY C L E R K
FOR DOMICILIARIES OF STATES OTSER THAN THE STATE OF FLORIDA:
ere y ec are t at my omici e s n the State of and that I intend
to penaanently 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 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.)
491650
1980 .PJ' -2 ~ ~ 35 -
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sworn to and subscribed before me this day of , A. D. 19
notary Pu 1c State o F on a at Large.
My Commission expires
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