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DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller] ST. Ll1CIE County, Florida.
This is my declaration of domicile in the State of ?Co.+,Ldcc , that I am filing
this day in accordance and in conformity with Section ., F or a tatutes.
FOR DOMICILIARIES OF THE STRTE OF FLORIDA:
I hereby. ~~clare that I reside in and maintain a place ~of a~de at ~4 ~. Ca.LiI~L•e .
: 1~. :~ s ree an n er
i o+,t S~t. Lu.c.~e , in ST. LU~ I E County, Florida, which place of abode I
city
recoqnize and intend to maintain as ~ay permanent home and, if I maintain another place or
places of abode in some other state or states, I hereby dec2are that my above-described
residence and abode in the State of Florida constitutes my predominant and principal haae,
and I intend to continue it permanently as such. I am, at the time of makinq this declara-
tion, a bona fide resident of the State of Florida residinq at 14 £n~_('~.r;l~ro~n •
street an number)
Po-3,t_ ~,t. Ltcc,i.e , in S'. rit.c,i.e Coun~y, Florida. I formerly resided at
c ty ~
Pon,t.i.a,c , G~k(nnd County, `~~uga~t , and the
city stateT
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.)
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Sw~ ~m f~ ~ s~sc.`ribed before me this ~~ day of = f(Jk :Jl~ 2 Y , A. D. 19~_.
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:.,~ ' "~ .: f~ .:~L~~~ ROGER P01 TRA S, CL ERK C I RCU i T COURT
ST. LUGIE COUNTY, FLORIDA
~7bta~y.~ , ~~ te o F ori a at Larqe.
My~. ae ires /a/iJ1g~ BY ~EPUTY CLERK
~~ f~ ~ ,~ •
FOR DOMZCI•L'2~tIES OF STATES OTHER THAN THE STATE OF FLORIUA:
ereby dec are t at my omicile is in the State of and that I intend
to pennanently continue and maintain my domicile in suc state. At t e time of making this
declaration Z am a bona fide resident of the State of My place of
abode ~ithin the State of Florida, if any, is as follows: Here ist 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 perfonoed by such person which such person desires or intends not to be
construed as evidencing any intention to establish his danicile within the State of Florida.)
51~'73p
1981 F~F; 23 P~ 2: 2~
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signature
Sworn to and subscribed before me this day of , A. O. 19
r~otary P ic State o F or a at Larqe.
~:y Commission expires
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