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=DECLARATION OF DOl~lICILB
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To the Clerk of the Circuit Court [County Comptrollers ST. LUC I E County, Florida.
This- is my declaration of domicile in the State of ,~D/P ~ A , that I am filing
this day in accordance and in conformity with Section ~~:I~I-ir~cTa Statutes.
FOR ~0l~lICILURIES OF TH8 STATE- OF FLORIDAs
I hereby declare that I reside in and maintain a place of abode at QpL~ PALOMAR S T,
D a ee _ an n er
Fo ~ r T" / E' CPC r- in ST. LUG 1 E County, Florida, which place of abode I
c y
recognize 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 haae,
and I intend to continue it permanently as such. I am, at the time of ~inq this declara-
tion, a bona fide resident of the State of Florida residing at Qr
pq~ ALD/'fA~f S T
stree an num r'~
Fo A ~3 Y Ie C £ , in ~ 7, ~ G(C / t -County, Florida. I fo~ resided at
MFR C E'i7 . - M FaP e ~ ~ County, and the
c y sate -
place or places where I maintain another or other place or places of abase are as follows:
(Here list street address, city, county and state of any other place or places of abode.)
No~~
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~ ` C'~UMiY signature -
Sworn to and subscribed before me this ~ / day of , A. D. 190 a .
~ - _ - ROGER P01 TRA S, CLERK CIRCUIT COURT
- - ST. LUCIE COUNTY, FLORIDA
{ Notary c State o F on a at Large.
f My Commission expires BY~ DEPUTY C L E R K
FOR DONlICILIARIES OF STATES OTHER THAN TAE STATE OF FLORIDA:
F er y ec are t my omic a sin 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 My place of
abode within the Stag of Florida, if any, is as follows: Here ist street address, city,
and county of -place of abode -itr -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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TRAST
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signature-
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Sworn to and subscribed before me this day of , A. D. 19
notary c State o For a at Large.
*iy Commission expires •
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