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:~~~;_DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller ST. L UGIE County. Florida.
This is my declaration of domicile~in the State of I that I am filing '
this day in accordance and in conformity with. Section , or a tatutes.
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FOR ~OMICILIARIES OF THE S'PATB OF FLORIDA:
i hereby declare that I reside in and maintain a place of abode at _ 7 0 ! H O t,, t., ~ ~Q vim,
~o !L T ~~_r_~2 ~ e=- in _ ST. LUC 1 E County, Florida, whichrplacenofnabode I
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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 home,
and I intend to continue it permanently as such. I am, at the time of making this declara-
tion, abona fide resident of the State of Florida residing at y o -~oc~ v ~ ,
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Fo R r` j~f in $ ~ ~ v C. t ~ County, Florida. I f ormerly resided at
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~ ~ U- v S , - ~ o ~ a o Is i°f crr 1~} County. N ~ = Lu 0 2 1,! , and the
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place or places where I maintain another or other place or places of abode are as follows:
(Here ifst street address, city, county and state of any other place or places of abode.?
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Sworn to and subscribed before me this day of ,
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" R GER PO i Tit a s, Q T-~~COUR T
ST. LUG I E COUNTY;'
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Not Pu lc State o F on a at La 'h~~~•:"
My Commission expires BY ~ DEPUTY CLERK!
FOR DQMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDiA; 4
er y ec are t t my omici a sin the State of and that I intend .
to permanently continue and maintain my daaicile in suc state. At a 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.)
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1980 JUI. -3 fly ~ 42
S t~6ER P i RAS ~
CLERK CtRCU11F Q #
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signature
Sworn to and subscribed before me this day of A. D. 19
Notary P c State o For a at Large.
My Commission expires
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