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493418
• ~ :~ll~: DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller) ST. LUC I E County, Florida. I
This is my declaration of domicile in the State of , that I am filing
this day in accordance and in conformity with Section , or a tatutes.
FOR ~OiMICILIARIBS OF THS STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at /7 ,8.. .~..~Y ~r•• ,
s ree an n err
9]'. ST. Lu P i in - ST. LUC I E County, Florida, which place of abode I
c y
recognize and intend to•maintain as my permanent hone and, if I maintain another place•or `
places of abode in sane 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, a bona fide resident of the State of Florida residing at / 7 89 SE ~.c.,?..~Lrt.
/789 BuR~ANAy ~^N street an nwn~efr
i • S 1 Lu ~ ~ ~ in 5T ~ ; { County, Florida. I formerly resided at i
c. ty ~ ~
/G I k Y!7 u . ~ .D..r . ~ County, v; , and the I
c ty sta e ~ - t
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:)
~r~~r~Y c. x.1:11
5~ e~P~~ - I'. ~1~ 11
°c ' ~ signature
, _
Sworn to and subscribed ?L~ ~ " ~ his d) day of , A. D. 19~
ROGER PO I TI2AS, CLERK C IRGUI T COURT
- ST. LUC I E COUNTY, FLORIDA
Notary Pu is State o F on a at Large.
j My Commission expires BY ~ DEPUTY G L E R If
FOR DOMICILIARIES OF STATES OTHER-THAN~THE STATE OF FLORIDAA: -
er y ec are t my omic e s the State of and that I intend
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 HY place of
~ abode within the State of Florida, if any, is as follows: Here ist street address, city,
and county cf place of abode in Florida.)
(Person making declaration may also include such other and further faets-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.);
493418
~ -
~ _ 1980 JtA. 21 IW ~ 39
FIL`~ .f ~
t R06ER RA~-
~ - - CLERK CIRCW
Rfca+o ~~aiv~~o -
- signature
f.
! sworn to and subscribed before me this day of A. D. 19
P7otary P is State o For at Large.
My Commission expires I
. ~
- 335 p~ - 611
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