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• ZI• : DECLARATION OF DOMICILE ~~~~~"~'~V .
To the Clerk of the Circuit Court (County Comptroller] ST. L UCIE- County, Plorida.
This is my declaration of domicile in the Stats of , that I am filing
this day in accordance and fn conformity with Section g , or ~~tatutes. .
7
FOR ~OMICILIARIES OF THE STATE OF FLORIDA:
. ~ y~Q~ s . ~~2b~ ~fs~acQ
I hereby declara that I reside in and maintain-a place of abode at ~ ~ ~ ~O ,
.f n c~ n s ree an n r
yt~'~ /".~PJc~1z, r~r'u, , in ST. LUC 1 E County,- Florida, which place of abode i
c y
recognize and intend to maintain as my permanent home snd, if I maintain another place•or
places of abode in some other state or states, Z hereby declare that my above-described
residence and abode in the State. of Florida constitutes my predaninant and principal bane,
- and I intend to continue it permanently as such. I am, at the time o€ makfng,th~a declara-
tion, a bona fide resident of the State of Florida residing at oZ~Q7 S• U~t,I.~J}s~,tp ~G/~
v, s ree an n er
~~iv , fn ~ r~ County, Florida. I formerly resided at
c y ~
0 1 ~~~,Q./~ ~ County, ~'t,ef,~ ~~C_ , and the
cty ae
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.)
o ,
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f ~~t ~ ; ~ ~ sigma ure
c~` 6'CU:.1V.F`y
sworn to and subscr d before me this /7 day of A. D. 19 ~U .
R GER P01 TRA S, GLERK CIRCUIT COURT
ST. LUC I E COUNTY, FLORIDA
Notary Pu is State o F on a at Large.
My Commission expires B Y ~1c%~-~~~L DEPUTY G L E R
i FOR DOMICILIARIES OF STATES•OTHER THAN THE STATB OF FLORIDAA:
~ ere y ec are t t my- c e s the State of and-that I intend
to permanently continue and maintain my domicile fn 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: ere ist street .address, city,
and county of place _of abode in Florida.) 4•
(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 daaicile within the State of Florida.)
49;3~~20
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signature
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Sworn to and subscribed before me this day of , A. D. 19 j
Notary is State o For a at Large.
My Commission expires
b~~335 QA~E ~i~
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