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493961 ~ - ~
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• - : DECLARATION OF DOMICILE
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To the Clerk of the Circuit Court [County Comptroller) _ST. LUCIE County, Florida. ,
This is my declaration of domicile in the State of ,~~~0 , that I am filing
this day in accordance and in conformity with Section.3Z~ , or a tatutes.
FOR•UOMICILIARIES OF TSE STATE OF FLORIDA: ~ ~
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i hereby declare that I reside in and maintain a place of abode- atJr`~`~5 ~11rn O AVP- .
lel in ST. LUGIE County, Florida, whichrplace ofnabode I
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recognize and intend to maintain as my permanent have and, if I maintain another place-or
places of abode in some other state or stator's, I hereby declare that my above-described
residence and abode Yn the State of Florida constitutes my predominant and principal haae,
- and I intend to continue it permanently as such. I am,.at the time of making,this declar -
tion, a bona fide resident of the State of Florida residing at f ~I+IS '{~Irrr~ Ar'
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I~epCC , in Le County, Florida. I formerly resided at 1
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S , ~ ~n k County, (I r'ld?S and the
city 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.)
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f,''~•.......~•''~ fir` ~ (.~S~f'~ se nor obeR~-~
Sworn to and subscribed before me~this day .of , A. D. 19
ROGER P01 TRA S, CLERK G I RCU I T COURT
ST. LUEIE COUNTY, FLORIDA
xotary Pu s.c State o F on a at Large.
My Commission expires BY QQse.~ ' i~ DEPUTY G L E R K ;
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF 1~LORIDiA:
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ere y ec are t at my omic e s i.n the State of and that I intend
j 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 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 intenda_not to be
construed as evidencing any intention to establish his domicile within the State of Florida.) y
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_493961 signature
Sworn to and subscribed before me this day of , A. D. 19
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?7 P 1c State o For a at Large. ~
My Commission expires #
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