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Si8259
~OECLARATION 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 _~~r~22.17C,CL. • that I am filing
this day in accordance and in conformity 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 ~f~~ i .
street a n er~
~'} .~i er' C~ . in ST. LUC { E County, Florida, which p~ace of abode I
(city)
recognize and intend to maintain as my permanent hotr+e 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 time of making this clara-
tion, a bona fide resident of the State of Florida residing at ~/~ ~_~~ /~L„ -1 f_ .
y~treet an n er
~ ~ , ~~ ~ ~ ~ ~ , in S~ , ~~~.,~ (' , f ~ County, Florida. I formerly resided at
~ (city) ~
~y County, l1~ ~ S~,n..r ~ , and the
~~ city ~ ~~ I ~ (state)
place or places wheze I maintain another or other place oz places of abode are as follows:
(Here list street address, city, county and state of any other place oz places of abode.)
~ BECAME A RES I DENT ON THE ~S DAY OF ~f' ~_ ~ 19~~.
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_ • (signature)
~~CQ~NT
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Sworn to and subscribed before me this a b day of o'4=~~ ~ A. D. 19 ~l .
ROGER PO I TRpS, CLERK C fRCUI T COtk2T
ST. LIJG I E COUNTY, FLOR t Dp
`tiotary Public State of Florida.at Large.~
My Commission expires . BY ~~~~` ~7~u~ DE PUT Y C L E R K
I'OR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
: ereby declare t at my domicile 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 domicile within the State of Florida.)
518259
19~1 F~~; 26 A,~S :I~ 58
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(signature)
sworn to and subscribed before me this
day of , A. D. 19
"~otary Public State o~ Florida at Larqe.
My Commission expires .
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