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.493625 • ~ 1
• ri~,.DSCLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller) ST.' LUC I E County, Florida.
This is my declaration of domicile in the State of F[,nQ.~Q~ , that I am filing
this day in accordance and in conformity with Section , Iori7a 3`tatutes.
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FOR ~giICILIARIES OF THE SATE OF FLORIDA:
i hereby declare that, I reside in and maintain a place of abode at yy~ 6iZto~9cyoa~ ,
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P~~ t-~. (.u~ R in ST. LUG I E County, Florida, which place of abode 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 saane 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 declares-.
tion, a bona fide resident of the State of Florida residing at n~e~~.~•
Via.
- - ~ - st:?e~ and nuz er
f o2~ S~ ~u_~~~ , in St. Lice Q County, Florida. I formerly resided at
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isRRn,n~ /3,4~ - - nlnB ~ (.~c County, L , and the
c ty sate
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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Swori)"t+~'~,~ubscribed before me this day of , A. D. 19
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GER I TRAS, CLERK IRCUI T COURT
T I E COUNTY, FL [ Da
Notary Pu is State o F on a at Large.
My Commission expires BY c- DEPUTY C L E R K
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF RI
ere y ec are at my omic a is the State of and that I intend
I 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.) -
(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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EPWTI~A~R' -
~1.ERK CIRCUIT COtRt _
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RECORA YERif
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Sworn to and subscribed before me this day of A. D. 19
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N;,tary P`v... SC State o F_er__a a*_ T-arge:
!~y Commission expires •
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