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DECLARATION OF DOMICILE ~~~~~0
To the C:~:k of t':e 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 confozmity with Section ., Florida Statutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~-~. 7~~f~~7 ,
~-~ ~~ .~ (street and number)
, in ST. ~ ~ ~C 1 E County, Florida, which place of abode I
(city) , .
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 hoine,
and I intend to continue it permanently.as such. I am, at the t' e o a~~c~_this declara-
tion, a bona fide resident of the State of Florida residing at ~~. 1~X 7 .
~-~ ,~ ~ ~ street and number)
, r Ccit ) ~ 1` ~;" ~}r" County, Florida. I f~R l~y resided at
~-~ ~ ~ ~~~~~= Y ,-~ i ; ~ ;~ Count ~~ ~
~ - ,~ . _ . y, y,,~ , and the
~~lty) state
place or places where I maintain another oz 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.)
BECRHE A RESIDENT ON THE ~ OAY OF ..._;~JJ , 19 ~,/ .
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Sworn to and subscribed before me this ~'rJ
`:otary Pi:blic State of Florida at Large.
"".y Commission expires ,
t/ j , *.~oT~. L C.t, l-1'm ~u ~ - ~ ~ '
day of ~ _ , A. D._19~. . _
ROGER PO I A S, CL ERK ~ C~jRCU f T EOl~2 T
ST`` ~~Ll1G I E COUNTY, Fl~ I L~P -
BY~`~`'~-~~ EPUTY. CLERK
~
f'OR DOMZCILIARIES OP STATES OTHER THAN TRE STATE OF FLORZDA:
~
Z.ereby declare t a~i~ domicile is in the State of and that I intend
to permanentl_y 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 makinq declazation may also include such other and further facts ~rith reference to
an}• acts done or performed by such pezson r+hich such person desires or intends not to be
~onstrued as evidencinq any intention to establish his domicile within the State of Florida.)
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s:oorn to an8 subscribed before me this day of
, A. D. 19
~:otary Public State of Florida at Large.
'!y Commission expires .
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