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To the Clerk o° the Circuit Court ICounty Cc°~trolierl ST~ Ll1C I~ Co~nt~•, Fiozi~~.
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':ais is m~• dec~aration o° nomicile in the S~a~e ~o° ~ , tr.a~ I ar.. `i_~. _
*.:::s day in accoraance and in conformity wit:^. Sectio^ c~~. ~, Fiorada Sta~u~es.
L'~F D3MICILIARIES OF THE STATE OF FLORI~A:
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: hereby declaze that I reside in anC maintain a place ot abode at / ~r'2.~.~r_~C~-2~.~`j~Lx~.
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~_ a~L •L~.cc.tt~.e , in ST_ 1 1~}r t~ Cosr.~~•, Fiorida. which~olace^e:'abc~e :
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' FC0~:112E dAG~ ~nten~ t0 Sf'.d1I1~d1I1• a5 1't}' D~_^.'.~.F::~ .^._"° 2'~.'~., ~s I r..~_::~Z1J3 $^C~::~7 L~?~= C.
:aces of abone in some other state or s:.a~es, I i:e::•:,•: ceclare ~:.a~ my above-cesc::~~~
-~siaence and abode in the State of Florica cor.sti_•~tes r..}~ preno.:.inanf and Frinc~~ai ^~^e,
3nd I intend to coatinue it oermanently as suc'r.. I a.z, a~ the time of makina tr2s cec~e:a-
_ion, a bona fi3e resident of the State of F~orida zesiding at ;~ ~7lC~iit~.~ GU ,
c,y~ \ ' ( street anc :.~.:.~: 1
,,~-f ~~L ~ O`~,t,`c~c..<. , in ~~ ~.C~-~ ~- County, Florida. I formerly res.eed at
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,~~i~t ~cc~c . ~i.~-~c~t~~._Qz~ County. L(1,Gs-c'd-x-~-c-. -' . and t?~e
(city) • (state)
:~iace or p2aces where I maintain another or other place or places of aboae are as follows:
~~ere list stteet address, cit~, cour.ty and state of any other place or places of abode.)
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Po~~ St luue Fl 3J45~
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Ss,ron¢„~p,,,~d subscribed before me this i9 day of gebruarv , A. D. 19~_.
r~~~ ~~~`'~l j~''~•,~ ROGER P01 TRaS, CLERK GaRCUI T COl1~T
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,~.~; =t.,, , ys~~l-<<l,r<<l~ ST. LUCIE COUNTY, FLORIDp
~=!~t, ~O, , te of Florida apTLarge.
' M~ ~~1SS~ A~t iresNo}Ary Public_ State of Florrda at Larqs B Y ~E P U T Y C L E R K
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t~~ ~^ C~SS' OF SATATESmOTHER %~THAIJ T~HE STATE`OF FLORIDA:
~ • e t at my omicile is in the State of and that Z intend
to. ~~~y continue and maintain my dcnaicile in such state. At the time af r~akina this
~eclartit~'~ih Z am a bona fide resident o~ the State of ~ . My place of
~~~de ~,rithin the State of Florida, if any, is as follows: (Here list street ad~ress, ci*_}•,
~zd county of place of abode in Florid~,.) ~ •
'~erson making declaration may also include such other and further facts with reference to
•:~y acts done or -perforn?d bj svch person w:~ic'.: such person desires o~ ir.tends nei to ~e
:.~nstrued as evidencing any intention Lo es:ab2ish his domicile within the State of F=~~ica.)
. 1981 ~~ ~. 26 ',~: T <<~
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SI LICi[ CG~.~- :•:' .
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Sworn to ar.d subsczibed befoze me this
~.~:.ary Public State o: Fiorida a: Larae.
~'~: Co:~r.iission expires .
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(signature)
day of , A. D. 19
!~'~'"T 349 f~~f i16?
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