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. ZIP :.DECLRRATION• OF DOMICILE • - ~ . ' -
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To the Clerk of the Circuit Court~~'ICpunty Caaptroller] - ST, LUG 1E County,- >?lorida.
This is my declaration of domicile.. in the State of FLp iQ I ` that I am filiinq .
this day :in accordance and' in conformity wit?? Sect~n»~~'~'37; FI-ir'~aa 'S'tatutes.
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FOR ti01lICILURIES OF THE STATE OF FLORIDA: -
I hereby declarg that I= reside in and maintain a place of abode - at a tl-~ . {
t~ ree an. •n -•r •
~RT S1-. t! U ~ I E in ~ LUG 1 E - ~ .County, >Plorida, which place of . abode I
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recognize and intend to maintain as my permanent haoe and, if I maintain another place•or
places of abode in sage other state or states, I hereby declare that my above-described
residence and abode in the-State of Florida constitutes my predominant and principal:haae,
- and I intend to conkfnue it permanently as such. I am, at the t of along th declara-
tion, a bona fide resident of the State of Florida residing at l~a - ~ ' ~UM'~-( ,
~ ~ >r. in . L,UC 1~ Count ,.Florida. street
an'd' n er
R`t U e 1- y I formerly • resided at
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~ ~ ~ F aci e i-t~( . (Y1 ~ M A u~ county. _ A R I ?6 IU A~ and -the
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place or 'places where I maintain another or other place~or places of abode are as follows:
(Here iist'street address,~city, county and state-of any other place or- places of abode.) •
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Sworn to and subscribed before me this ~ day of , A. D.-19~.
j - OGER I TRAS, CLERK CIRCUIT COURT
ST. I E COUNTY, F I DA
Notary Pu 1c State o F on a at Large. -
j My Commission expires - BY DEPUTY CLERK
FOR, DO~lICILIARI$S. OF .STATES OTHER THAN THE STATE OF
A
er y ec are t 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 !!y 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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signature
Sworn to and subscribed before me this day of , A. D. 19 •
~ P7otary P is State o For a at Large. ~
My Commission expires itg' ~ '
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