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' ~ :~~~i.OECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller] ST. L UCIE County, Florida.
This is my declaration o! domicile in the State of i , that I am filing
this day in accordance and in conformity with. Section , or da
Statutes.
. -r
FOR tiOMICIL2ARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at~j/ .Se t,ICL~ ~ ~i9~~
/ 'mss
r~ee an nwiTer
oc c,/C'%C , in ST. LUG 1 E County, Florida, which place of abode I . }
recognise an3d intend to maintain as my permanent home and, if I maintain another place•or f
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 home,
and I intend to continue it permanently as ouch. 1 am, at the time of making this c~eclara-
do , __a bona fide resident of the State of hlorida residing at S/ / S E. ~U~.L/Q _ ,L •g~/~
s res an n r
O/?~ ~UC/E , in ~T -.l uC/~ County, Florida. I formerly resided at
c _ ~
y - Count
T,F'En/~~o
? ~~C ~/2 - Y. and the
city) 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.)
G!~sJflty
F,.J f • _
U' .y r~/% / ~ i
sign ure
~`'<<.cu~~iv.~ Lori s ('i2Ma.d~
Ii Sworn to and subscribed before me this oZ9 day of , A. D. 19
j ROGER PO I TRAS, CLERK CIRCUIT COURT
ST. LUGIE COUNTY, FLORIDA
Notary Pu 1c State o F on a at Large. r1 -
~ My Commission expires BY ~'/~U~ DEPUTY CLERK s
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDiA:
er y ec are t my c e s n 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 HY 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 evi~,n~c~~~ intention to establish his domicile within the State of Plorida.)
19~ Jl~: 29 III 1 I ~ 39
FiIED A RECDRDf0
S R TY.FtA.
PbITRAS
aEryQ~IRCU11 COURT
RCCORD YCRIFIEO-_
-
signature
-
Sworn to and subscribed before .me this day of , A. D. 19
Notary P c State o For at Large.
My Commission expires
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