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DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptrollerj ST. L UCIE
T-
County, Florida.
This is my declaratioa of domicile in the State of t~d~0. , that I am filinq
this day in accordance and in conformity wfth Section , Florida Statutes.
FC~R DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~~ ~c~ iis t~~r~•,
(street and number)
~. ~ , in ST_ L UC1~ County, Florida, which place of abode I
city
recoqnize and intend to maintain as my pennanent 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 S~ate of Florida constitutes my predominant and principal home,
and I intend to continue it permanentiy as such. I am, at the time of making this declara-
tion, a bona fide resident of the State of Florida residing at ~jf~,~p ; un~~ ) .
Q ~
t''~• l/ei'«: , in ~~-, ~ k~; ~ County, Flor da ~Itformerly resided at
/'~ ity) ~
~,1.[~n ~Ot.aL' . //¢ SSa w County, /(J~.y ~ r~ , and the
(city) - (state)
p?ace 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.)
' BECAME A RES 1 DENT ON THE S DAY OF ,,~_~~ ~ s I9 ~0 .
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,.,_"-- - ~ (signaturey
~. . , . _ ' _
Y`'~' ::: ~~-~'~~ .
Sworn to and subscribed before me this o2S- day of ~'~1ss.~ , A. D. 19 g~ .
ROGER POI TRAS, CLERK G IRCUI T COURT
ST. LIJC i E COUNTY, FLOR I DA
~:otary Public State of Florida at Large. _~~
My Commission expires . BY ~~~~~ DE P U T Y C L E R K
FOR DOMICILIARIES OF STATES OTHER THAI3 THE STATE OF FLORIDA: ~
: ere y ec are t at my omicile is in the State of and that I intend
cc permanently continue and maintain my domicile in sucri state. At the time of making this
deciaration 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 further facts with reference to
any acts done or performed by such person which such person desires or intends not to be
~^nstrued as evidencing any intention to establish his danicile within the State of Florida.)
51bi121
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. (signature) -
;worn to and subscribed before me this day of , A. D. 19 .
':otary Public State of FYorida at Large.
'~y Commission expires .
g~~K349 p~~E 993
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