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• ~ ::DECLARATION OF DOMIICILE
To the Clerk of the Circuit CourE [~ountY Camptsoller~ ST. LUCIE County, Florida.
This is my declaration of domicile in the State of ~~OQip~} , that I am filing
this day in accordance and in conformity with.8ection , or a tatutaa.
- ~
FOR~bOMICILIARIES OF THE-STATE OF FLORZDAs
i hereby declare that .i reside in and maintain a place of abode at f ~O X ~a5~ . -
s ree~an'a n er
-TZ ,O i t r , in ST. LUG I E County, Florida, .which place of abode I
~ Y
recogRiae and intend to maintain as my permanent home and, if I maintain another place•or
places of abode in some other state or states, I hereby declare that my above-described
residence and abode in~the State of Florida constitutes mY predominant and principal hens,
- and I intend to continue it permanently as such. I am, at the time of making this declare-
Lion, a bona fide resident of the State of Florida residing at O Y as
- s ree an ~ n r
~ r ~ O/t /"C . in ~'-f L/,r r i~ e. County. Florida. I formerly resided at
c t ~
`~~Q S ~ ~j~ County, ~ ~ ~ , and the
c y 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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C~c ~CUNiY.F` J e /IN So~1
Swore to and subscribed before me this d 5 day of , A. D. 19 ~ .
. ~ R GER P01 TRAS, CLERK CIRCUIT COURT
ST. LUG[E COUNTY, FLORIDA
Notary c State o For a at Large.
My Caomission expires BY ~ DEPUTY C L E R
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDAb
er _y ec are my c e s the State of and that _I intend
to permanently continue and maintain my dpsicile in suc eta e. 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 st 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
Notary is State o For at rqe.
My Commission expires
~ P»~1597