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DECLARATION UF DOMICILE
518109
To the Clerk of the Circuit Court [County Comptroller] ST. L UCIE 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 ., F orida Statutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at '~~/ ,
; . (street an nu er
- ~ , in ST. ~ UCIE County, Florida, which place of abode I
~~ity
recognize 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 ~ 7/ ~~~o ~,t , ~
,,~~ (street an num r)~EvA~S
~ ,~n ~ ~~ County, Florida. I formerly resided t
, _ city) ~
, County, s , and the
city state)
place or places where I maintain another or otber place or places of abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.)
I BECAMIE A RES I DENT ON THE ~~ DAY OF _~~ ~ 19~ .
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Sworn to and subscribed before me this ~S day of ___L.~''" . A. D. 19 y"/ .
ROGER PO I TRp S, CL ERK C i RCU I T COUR T
ST. LUC I E COUNTY, FLOR I OA
tiotary Public State of Florida at Large. '
My Commission expires . BY ~ ~~ ~~~ ~E P U T Y L L E R K
FOR DOMICILIARIES OF STATES OTHER.THAN THE STATE OF FLORIDA:
I ereby dec are t at my domicile 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.)
(rerson making 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 inteads not to be
construed as evidencing any intention to establish his damicile within the State of Plorida.)
51t~109
19E! ~~`; 25 :': I: ~~ -
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sworn to and subscribed before me this ~° ~~ day of C=~IL1'~J"" . A. D. 19 ~/.
`Iotary Public State of Florida at Large.
*~y Commission expires ,
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- ""3~9 P~~~ 981
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