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493542
• : ~~=DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller) ST. L UCIE County, Florida.
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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 ~OMICILURIES OF THE STATB OF FLORIDA: •
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I hereby declare that I reside in and maintain a place of abode at 1~ ~ U Q ~ Q r~ ~ k) ,i l~ ~ 1~ •
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~c~Z ~t, r i~ , in ST. LUC I E County, Florida, which place ofnabode I )
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recognize and intend to maintain as my penaanent 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 waking this declara-
tion, a bona fide resident of the State of Florida residing at /~a S' ~ ~ r a o. ~ ~ i~ t to .
street n r
~eN~ 5~ = 4 C_ in Ste. rc ~ , Q County, Florida. I formerly resided at
c ty _ ~
Count ~ N p . ~ .1 a and the
~egh P a ~ t~e_ y. T_•
city s a 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.)
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. _ . . - signature
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Sworn to and subscribed before me this d~ day of , A. D. 19 ~ .
ROGE1,2 P01 TRA S, CLERK CIRCUIT COURT
ST. LUCIE COUNTY, FLORIDA
Notary Public State o F on a at Large.
~ My Commission expires BY ~ _ DEPUTY CLERK
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~ FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDAA:
` er y ec are at my omic a is 1r: 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,
l 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.)
s 493542
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pEt~D YEP1FiED
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signature
~ Sworn to and subscribed before me this day of , A. D. 19
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Notary P 1c State•o F on a at Large.
My Commission expires
°R335 P~ 807 i
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