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. 494400
• ~ 'TI~ DECLARATION OF DOMICILE
- To the Clerk of the Circuit Court [County Canptroller) ST. LUG I E _ County, Florida.
This is my declaration of~domicile in the State of ~~r ' , that I am tiling
this day in accordance and in conformity with. 8ect~on Z~Z:1~7 ; Florid-a'~'tatutes.
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FOR ~OMICILIARIES OF THE STATE OF FLORIDA:
i hereby declare that I reside in and maintain a place of abode at ~gp f~=iQco/~.,. S
"-Ts ree an nu er~
o~~~.'.,1~ L ~...'P in ST. LUG 1 E County, Florida, which place of abode I
recognise and intend to maintain as my permanent home and, if I maintain another place•or
places of abode in some other stat8 or states, I hereby declare that my above-described
residence and abode in the State of Florida constitutes my predominant and principal hale,
- and I intend to continue it permanently as such. I am, at the time of makin this declara-
tion, a boaa fide resident of the State of Florida residing at d81CL ST.
- (s ree an num er
Pn. ~ f Luc a• . in S'a.'.. t 1~...'~ County, Florida. I formerly resided at
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Co.... ~ _ ~,.c
o~.- ~ • .i;~G c~,c ,F County. _T~. a e „ and the "
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place or places where I maintain another or other place or places of. abode are as follows:
(Here ;ist street address, city, county and state of any other place or places of abode.)
. ~ /9~y J .
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c ~ ~~Ct2~y ~ruN ~y oN S
Sworn t~ ~;pub~.. fore me thfs`~ day of ~ , A. D. 19~.
l~ ~ OG POI TRAS, CLERK CIRCUIT COURT
a'~~• - ~ ST LUG I E COUNTY, FLOR 1 DA
~ Notary Pu c o f on a at Large.
My Commission expires BY DEPUTY CLERK
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FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
f
er y ec are t my c e s the State of and that I~intend
~ 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 intends not to be
construed as evidencing any intention to establish his domicile within the State of Florida.)
494400
1980 J~ 30 ~ 3Z _
r Ott CIi~MT 7~
~ ~coaa ~R~F~o_ \
signature
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~ Sworn to and subscribed before me this day of , A. D. 19 t
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Notary is State o For at Large.
My Commission expires
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