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51'7''720
DECLARATION OF DOMICILE
To the Clerk of the Circuit Court ~Caunty Comptroller] ST. L UCIE County, Florida.
This is my declaration of domicile in the State of ~LDiP~D N , that 2 am filing
this day in accordance and in conformity with Section 22~I3, Floricla Statutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA: #~ s
Z hereby declare that I reside in and maintain a place of abode at ~~ O/~c , r'C p ERp L l~~
(street an~n` a'bi er)
FC~ ER ~~ , in ST~UC 1~ County, Florida, which place of abode I
city)
recognize and intend to maintain as my permanent home and, if I maintafn 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 hane,
and I intend to continue it permanently as such. I am, at the me of making this d~clar
tion, a bona fide resident of the State of Florida residinq at~~0/- ,~ L,/-/W~~ ~~
~ ~ st eet an numbe:')
f"'O/~T ~~!_ (Z C C- . in ST. ~.11 C/~ County. Florida. I formerly resided at
~ (city) ~ 2T/fA~ ~~ t,~~~ _
f~ S To N . ~o Ml~ 1'o n1 County, /~- , and the
(city) (state)
place or places where I maintain another or other place or places of abode are as follows:
(Here list street address, city, county apd state of any other place or places of abode.)
BECAME A RES 1 DENT ON THE J~~~OAY Of FE(,31TURRY~ 19 ~~ .
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Sworn to and subscribed before me this ~~3 day of ~~ ~ , A. D. 19~.
_. ROGER PO I TRA S, CL RK G I RCU I T CQUR T
~ c\ LUC I E COUNTY, FLOR I DA
Notary Public State of Floricla at Large.
My Commission expires • . ~' DE P U T Y C L E R K
FOR DOMICILIARIES OF STATES OTHER TNAN THE 5TATE OF DA:
ere y ec are t at my omicile is in the State of and that I intend
to pertnanently continue and maintain my domicile in such state. At the tir,.A 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 makinq 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 ~+ithin the State of Florida.)
(9~1 FE~~ 23 .~!' :1= ~;;
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51~2ip
(signature)
sworn to and subscribed before me this
day of , A. D. 19
;lotary Public State ot FYorida at Larqe.
My Commission expires .
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B~x349 PAUE 254