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DECJ.ARATION OF DOMICILE
To the Clerk of the Circuit Court (County Comptroller) ST. LUC i E County, Florida.
This is my declaration of domicile in the State of -~ //~~ , that I am filing
this day in accordance and in conformity with Section , Florida 5tatutes.
FOR DOMICILIARIES OF THE S~'ATE OF FLORIDA:
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I hereby declare that I reside in and maintain a place of abode at ,~~,~5 kll ~/3 ~~ ~ J~ ..
~ ~ street and numberj
~~~(~i i~ t~c i r , in ST. ~UC 1~ County, Florida, which place of abode I
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recoqnize 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 making this declara-
tion, a bona fide resident of the State of Florida residinq at S ~l L j i%/~ ~ C i~ ,
7 ~1 .' street an~number)
~ c. {~ j 5 t` ~ v c! r , in c~ I ~ v ~ I N~ County, Florida. I formerly resided at
~J ~-~ ~~ ~ ~~--~-*~-~~R w n'i Count , ~t
__ '~ , y ~ t SC ~D N S//1i , and the
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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 o: places of abode.)
I SECANE A RESIDENT ON THE E~ O OAY OF SE7n1 ~ 19 ~U .
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5worn to ~and subscribed before me this ~3 day of ~ , A. D. 19 ~.
.
ROGER PO I TRA S, GL ERK G I RCU I T COUR T
ST. Ll1C I E COUNTY, FLOR I OA
Notary Public State of Florida at Large. ~
My Commission expires . BY ,~g.,,,,c~ DE PUT Y C L E R K
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FOR DOlKICILIARIES OF STATES OTHER THAN THE STATE OF FLORIUA:
ere y ec are t at my omicile is in the State of and that I intend
to permanenCly continue and maintain my domicile in such state. At the 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 list street address, city,
and county of place of abode in Florida.)
(Person making declaratfon 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.)
1981 FC: 23 ~~ ;1= S3
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sworn to and subscribed before me this day of , A. D. 19 .
~~otary PuriYic State of FYorida at Larqe.
'~y Commission expires .
s~o~349 Pa~E 244
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