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DECLARATION OF DOMICILE
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To the Clerk of the Circuit Court [County Comptraller) ST. LUC1E County, Florida.
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This is my declaration of domicile in the State of ~ , that I am filing
this day in accordance and in conformity with Section 23~7', Florida Statutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~~r^ ~~ ~~ ~'; rc - C: rc? ~
(street and number)
;'~~r ~'~ r ce , in ST r LUC I E County, Florida, which p~ace of abode I
Ccity)
recognize and intend to maintain as my pexmanent 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 ti.a4e~~f makin~ this d~clara-
tion, a bona fide resident of the State of Florida residinq at '~ C~hn - inc s-'-. '"cl c~ E.
_'c.~i: ! i: rcc~ S;;.l.ucie (street and number)
, in _ County, Florida. I formerly resided at
..tcitSy) _... ' ~~
. ;;c;a::..er 5 : )c: s ~ . r:.~s~;c' c~t; Count ~ ` ~'' ''~'r : ar.~. s , and the
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(city) (state)
place or places where I maintain another or other place or places of abode are as follo~,rs:
(Nere list street address, city, county and state of any other place or places of abode.)
l BECAMfE A RE51 ~ENT ON THE 1' ~AY OF '3~"'~ ~ 19 } .
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Sworn to and snbscribed before me this ~-S
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(signature)
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1 7
day oF._ t-~~2..« c,¢ ~z- , A. D. 19c~ ~.
ROGER PD t TRA S, CL ERK C I RCU 1 T COUR T
ST. ll1C I E COUNTY, FLOR t OA
":otary Public State of Florida at Large. BY - ~,~~,~4_. DEPUTY CIERK
*~y Commission expires . S~
FOR pOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
~by declare t at my domici~e 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 further 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 damicile within the State of Florida.)
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5181:36
(signature)
~worn to and subscribed before me this
day of , A. D. 19
'lotary Public State of Flozida at Large.
""y Commission expires .
~~'~349 P~~E1012
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