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51~666
DECLARATION OF DOMICILE
To the Clerk of ~he Circuit Court [County Comptroller) ST. ~IJCIE County, Florida.
This is my declaration of domicile fn the State of ~~ 0 V 1 d R , that I am filing
this day fn accordance and in conformity with Section 7z~.T3~ Florida Statutes.
FOR DOMICILZARIES OF THE STATE OF FLORIDA:
Z hereby declare that I reside in and maintain a place of abode at ~~ ~a y$ p ur ~, Y,
streef an~ n er
f f l~ i~ r~ e , in $T ~~ ~~ County, Florida, whfch place of abode I
Ccity)
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 home,
and I intend to continue it permanently as such. I am, at the time of makin this declara-
tion, a bona fide resident of the State of Florida residing at 13q~ ~,3aw s~ort .
( street and nu berrT~
/' ~. p i C!- c e , in S 7~ ~. ~! G i~ County, Florida. I formerly resided at
Ccity) ~i
R o ~ h~~~ ~ r . /y/ d~z r v P County, /I~G c,,~ a , and the
lcity) (state ~
place or places where I maintain anather 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.)
Ncne.
f BEC1-NE A RE51 DENT ON THE 1-S' OAY OF Ak ~~ t~ 19 `~J (L.
Sworn to and subscribed before me this ~~ day of l~--~ ~ , A~~
ROGER PO I 1RA S, CE
ST. LUCIE COUNTY,
Notary Public State of Florida at Larqe.
My Commission expires . B ~- ~
C ,,
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORZDA:
~~ :.`~ .
~: • ~ . !COURT
.~ ~ "
1 EPUTY G~ERK
ere y ec are t at my omici e is in the State of and that I intend
to pennanently continue and maintain my domicile in such state. At trie time of makfng this
declaration I am a bona fide resident of the State of . My place of
abo3e within the State of Florida, ff any, is as follows: (Hexe list street address, city,
and county of place of abode in Florida.)
tPerson 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 damicile within the State of Florida.) !
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1991 f C~s 23 ~'~ -;~ ~ 0
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5! LUCif i.CL'N' ~• f:~
RCCiER F'CtTR :ti n
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51'76b6
(signature)
sworn to and subscribed before me this
day of , A. D. 19 .
*iotary Public State of Florida at Large.
My Commission expirea .
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