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DECLARATION OF DOMICILE
'ro the Clerk of the Circuit Court [County Comptroller) ST. L UCIE County, Florida.
'rhis is my declaration of domicile in the State of F,L~` , that Y airt filing
this day in accordance and in conformity with Section :l~iaa 3`tatutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at 1~,~~ /ti f-: /~1~~,~y ~r,
^ street an nu er
r;l't Sf', ~ I~~~r . in ST. LUC 1 E County, Florida, which place of abode I
~city
recoqnize and intend to maintain as my permanent home and, if I mafntain 3nother 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 makinq his declara-
Lion, a bana fide resident of the State of Florida residinq at ~~,2,,? ,~/` ~_ in~~i•~v ii'..
T~eef-an nu er
~iE'T S~. ~ ~Ci ~ , in ~%, ~~~~ ~~ County, Florida. I fori!ierly resided at
ci yj ~
`r1 N~ R 5 TE /~ ~-'r ~. . ~~'/~- County, t.'~ k.~ ~1~~~~ , and the
city~ ~~ state~
place or places where I maintain another or other place or pla~es of abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.)
BECAMlE A RESIOENT ON THE ~ DAY OF ''J ~ j9~L~
~~~ COUIy~. c
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signa re
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Sworn to and su~scsibed before me this
tiotary Public State o F orida at Large.
My Commission expires
a-3 day of ~~t~,eR.~ , A. D. 19 ~l.
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ROGER POI TRAS, CLERK G IRCUI T COURT
ST. LUC i E COUNTY, FLOR I DA
B Y _~~,,,, o/(,~c,[ D E P U T Y C L E R K
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
ereby declare t at my omicile is in the State of and that I intend
to permanently continue and maintain my domicile in suc state. At the time of making this
declaration Z am a bona fide resident of the State of My place of
abode within the State of Florida, if any, is as follows: Here ist street address, city,
and county of place of abode in Florida.)
(Person making declaration may also include such othez 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 evidenci~g any intention to establish his damicile within the State of Florida.)
19$I Fc3 23 P~t ~~ F
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signature
sworn to and subscribed before me this day of , A. D. 19
r~otary Pu ic State o Flori a at Large.
My Commission expires
a
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