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51bi2'79
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 rlori da , that I am filing
this day in accordance and in conformity with Section 2~'FT~, Florida Statutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA: Ocean Villaye 3Ss4
I hereby declare that I reside in and maintain a place of abode at'4C?O S. Ocean . Drive `~
(street ana number)
l~ort Pierce , in ST. LUC I E County, Florida, which place of abode I
(city )
recoqnize and intend t~ maintain as my pennanent 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 time of makinq this declara-
tion, a bona fide resident of the State of Florida residing at 2~tnr~ ~ pcean Drive .
(street and number)
rt, 1'ierce , in St. Lucie County, Florida. . I formerly resided at
(city)
~.1alZinctford . Delarrare County, P~ansyvania , and the
(city) (state)
place or places where I maintain another or other place or places o€ abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.)
I BECANE A RESIOENT ON THE 6th
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signature)
Sworn to and subscribed before me this ~ day of
tiotary Public State of Florida at Large.
My Commission expires .
~~ ~ , A. D. 19~.
ROGER P01 TRA S, CL ERK C I RCU I T COURT
S. LIJC 1 E COUNTY, FLOR I Dp
BY \ ~EPUTY CLERK
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
~~e~y dec e 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 makinq this
declaration I am a bona fide resident of the State of . My place of ~
abode within the State of Flozida, if any, is as follo~s: ttlere list street address, city,
and county of p2ace 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
cons*_zued as evidencing any intention to establish his domicile within the State of Florida.)
1~°I F~' ~ 2a r.. 2: :. I
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~5182'79
(signature)
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S~~orn to and subscribed before me this
`iatary PubYic State of Florida at Large.
My Commission expires .
p~Y oF January ~ lq ~1 ~
day of , A. D. 19 .
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