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494354 - '
• DECLARATION OF DOMICILE
To the Clerk of the Circuit Court (County Comptroller) ST. LUCIE County, Florida.
This is my declaration of dwaicile in the State of ~ r~~. that I am filing
this day in accordance and•in conformity with. Section , Iariaa~`tatutes.
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FOR ~OMICILIARIES OF THE SATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at /
,
r'i ~ in - ST. LUC i E County, Florida, whichrplace ofnabode I
city
recognize and intend to maintain as my permanent home and, if Z 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 home,
- and I intend to continue it permanently as such. I am, at the time of making this decl~a-
tion, a bona fide resident of the State of Florida residing at /30l Firetb? !
-'Tetras an n er -
f-f• Pe<<e , in ~ uci a County, Florida. I formerly resided at
c y - - ~
~~~te , C S"~.A ~ County, ~ I I . , and the
c y ~ 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.)
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Sworn to and subscribed before me thisG~ day of , '~j/f~s,~. y ° "
- R ER I TRA S ' G~~RK ~ G' I RGU I T COURT
- _ S L I E GO , FLORIDA
Notary Pu lic State o F on a at Large. ~
j My Commission expires - d~-~ DEPUTY CLERK-
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF DiA
er ec are t t my omic a sin the State of and that I intend ~
r 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 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.)
494354 •
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AECCRO ~'ERii'tEi1.---
signature
Sworn to and subscribed before me this day of , A. D. 19
Notary is State o For a at Large.
My Commission expires -
335 P~2124
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