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S181~3
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 ~ p!e- j~ , that I am filing
this day in accordance and in conformity with Section ., Flori~tatutes.
FOR DOMICILIARIES OF~THE STATE OF FLORIDA:
I hereby declar that I reside in and maintain a place of abode at l O~ ~~-S ~ ,
~ ~ ~ ~ p ^ ~ ~ ~ (street and number)
Oi~ , in ST_ L UCIE County, Florida, which place of abode I
(city) ~
recoqnize.and intend to maintain as my permanent home and, if I maintain another p2ace 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 prednminant and principal home,
and I intend to continue it pe~anently as such. I am, at the time qf making this declar
tion, a bona fide resident of the State of Florida residing at _L~(~ {~C S T C•~Q I~L~l/~f
(street and number)
~~ 27 S~~ i v` -~ r- . in County, Florida. I fqrmerly resided at
(c~}-ty)
~Z ~l t~ ~'fl~ LS c.'~ D 6t ~ ~/ ~.~. ~ S~L. ('~ ~/~ c~:~ CounLy. S~~'~'vt-K~, and the
"' (city) (state) ~ ~
place or places where I maintain another or other place or piaces of abode are as follows:
t~:ere list street address, city, county and state of any other place or places of abode.)
' BECAHE A RESIDENT ON THE _a~ OAY OF .MA~~f7 ~ 19 S~J ~
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sworn to and subscribed before me thi~ ,~ j day o~.. ~~ , Ai ~.~~8'+~'; y~''~ _: -.
~ -ROGER P01 TRAS, ~}fQ~1C?~_'iJ~C~t;~ COURT
ST I E COUNTY,''•.~~ 'fU~~,'' ~
':otary Public State of Florida at Large. , ~ ••/ ~.;;;,:,,; .•
My Commission expires . /~_ -., ~~t/ ~E P U T Y C l E R K
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE O
I ere y dec are t at ny domicile is in the State of and that I intend
*_o 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 aithin the State of Florida, if any, is as follows: (Here list street-address, city,
and county of place of abode in Florida.)
'~erson 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 domicile within tt:e State of Florida.)
IA~~ r-
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.
(signature)
~worn to and subscribed before me this
, 1
day of
~:otary Public State of Florida at Larqe.
M;~ Commission expires ,
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