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. 51'759~
~ECLARATION OF DOMICILE
To the Clerk of the Circuft Court [County Comptroller~ ST. L UCIE County, Florida.
This is m declaration of domicile in the State of ~6 ~tt('~~ , that I am filin
this day in accordance and in conformity with Section ~~I3, Floricia Statutes. g
FOR DOMICILIARIES OF T}iE STATE OF FLORIDA:
I her~by declare that I reside in and maintain a place of abode at ~~U3/If~~~~'G~~~, ~Jfi .
~.._ ' (street an~7c nu er
~ fi ( , in $T. ~~~~ County, Florida, which place of abode I
city
recaqnize and intend to maintain as my permanent~home and, if I maintain another place oz
places of abode in some other state or states, I hereby declare that my above-described
residence and abode in the State of Florida constitutes my predominant and principal home,
and I intend to continue it permanently as such. I.am, at the ti.me of ma~c inq this declara-
tion, a bona fide resident of the State of Florida residing at ~Z13~ (/~~~ ~ ,
~ ~y n ` n street an number)
~o-c,Y /(~.-` ~ , in J~~` ~ `~c>unty, Florida. I formerly resided at
(cit ) . ~, ~$
_ - ~ ~ ~G c-~ ~ County, L ~Z~ , and the
city - tstate)
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.)
i BECANE A RESIDENT pN THE JS/ DAY OF /!~I/j~/~ ~ 19~_.
51'7594
193! F~~ 20 ':~~ 3~ 03
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Sworn to and subscribed before me this ~(Z day of , A. D. 19~1.
• ROGER PO I TRl~ S, CL ERK G 1 RCU 1 T COl~2T
ST. tUC I E COUNTY, FLOR I OA _
~otary Public State of Florida at Large.
My Commission expiries ~ . Btr ,~,Q.~-~ ~ci~~~q~EPUTY CLERK
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FIARIDiA:
1 hereby declare that my domicile is in the State of ~d~.,~,~ and that I intend
to permanently continue and maintain my domicile in suc state.. 7~~ the time of•making ~his
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: ~ere Iist 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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Sworn to and subscribed before me this
'+otary Public State of Florida at Larqe.
'~y Commission expires .
.~/
(S1 6)
day of , A. D. 19
~~~K 349 E~~~E 18
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