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4934'70 ~ ~
. ~ DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller) ST. l UGIE County, Florida.
This is my declaration of dam~cile in the State of F'/ ct. , that I am filing.
this day in accordance and in conformity with. Section ~~~IT-P`I-armada 3`tatutes. ~ ~
FOR tiOMICILLARIES OF THE STATE OF FLORIDA: t
I hereby declare that I reside in and maintain a place of abode at C'
c~ a tee an n er
no r't- J ? _ y C i e in ST. LUC I E County, Florida, which place of abode I
ci~yf
recognize and intend to maintain as my permanent home and, if I maintain another place•or
places of abode in same 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 con~~nue it permanently as such. I am, at the time of make, q this d c ora-
tion, a bona fide resident of the State of Florida residing at 3~.2C Ski ~oiy/e3
~ ~ s teat an n ~er
L O R~ ~ = f-y~~ C . in L ~ C i e County, Florida. I formerly resided at
~Cty) ~ z
.a...~' i
yN County, O Nil/ , , and the
c y sta e
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.)
- - ~-.d--
% ~6eTH ,j~ i ToMM.¢Sc
signs ure
Sworn to and subscribed before me this day of , A. D. 19~. ~
ROGER PO I TRAS, CLERK G IRGUI T GOURT
ST. LUG I E COUNTY, FLORIDA ,
Notary is State o F on a at Large. `
My Commission expires BY DEPUTY G L E R K~
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORID~Fi:
er y ec are at my omic e s the State of and that I intend ,
to permanently continue and maintain my domicile 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.)
I
j (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 danicile within the State of Florida.)`
_4934'70
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s~ R c
E RECORC
t signature
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Sworn to and subscribed before me this day of , A. D. 19
Notary P 1c State o For at Large.
E My Commission expires ,
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