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51'~8~36
DECLARATION OF DOMICILE
To the Clerk of the Circuit Court (County Comptroller) ST. L UCIE County, Florida.
This is my declaration of domicile in the State of ~~7L -~~-~~ , that I am filing
this day in accordance and in conformity With Section ., Florida 5tatutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA: /
I hereby declare that I reside in and maintain a place of abode at ` l~ ~~~~ _.
~~ ~~ ~~~~ i street nwnber )
~ , in ST, lUC 1 E County, Florida, which place of abode I
(ciLy)
recognize and intend to maintain as my.permanent home and, if Z 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 hame,
and I intend to continue it permanently as such. I am, at the t' e~ m i this eclara-
tion, a na fide resident of the tate o Florida residinq at ~~ J/~~t~ ~~
` ~ tstreet an m r
~ -~_t'-2~ _ F.~' , in ~-~~ ~" ZL~ t- v County, Flo ' da. I former esided at
, /" ~
~ Ld 1 y~ .+~-d , ~,.L ~~ thca._ County, ~~-~-~- ~~- , and the
~~ ~ ,
(city) // istate)
place or places where I maintain another or~Eher place or places.of abode are as follows:
(xere list street address, city,~county and state of any other place or places of abode.)
BECAME A RESIDENT ON TH C~ .DAY OF ~ 19 /~.
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Sworn to and subscribed before me this ~ C~ day of f"-~~ , A: -,~r'Y~ •. ~%
:.~. r:'~"
ROGER POI TRaS, :~~ l, IRCUI7~OURT
LUC I E COUNT~'' it ~+'~?R I OA. ; p:
`:otary Public State of Florida at Large. =:~~ '•~
My Commission expires . ~lr _ ~..«it-~!G '"•:'~~ `~' DE ~~k~ Y' C L E R K
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r OR DOMICILIARIES OF STATES OTHER THAN THE STATE F BA : '''~ Q~•~ ~-' ~~~`
. ., or.,,..:,.
1 ereby dec are t ai my omacile is in the State of and that I intend
to permanently 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 declaration may also include such other and furtheX 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 within the State of Florida.)
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(signature)
Sworn to and subscrfbed before me this
day of , A. D. 19
rrotary Purilic State of FYorida at Large.
My Commission expires .
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Pn;IK 349 QaUE 597