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DECLARATION OF DOMICILE
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To the Clerk of the Circuit Court [County Comptroller~ ST. L UCIE County, Florida.
This is my declaration of domicile in the State of Florida , that I am filing
this day in accordance and in conformity with Section 2~'~1~, Florida Statutes.
FOR DOMICILiARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at 1132 I,adner Street ,
Port St. I,uCie (street and number.)
, in S T: L UCIE County, Florida, which place of abode I
(city)
recoqnize and intend to maintain as my pennanent 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 predominant and principal home,
and I intend to contir~ue it permanently as such. I am, at the aking,.this declara-
tion, a bona fide resident of the State of Florida residinq at ~i~ ~a'~ner ~treet ~
Port St. I,ucie St. Lucie (Street ana number)
, in County, Florida. I formerly resided at
'Jero ~eachlty~ , Indian River county, Florida ~~~ and the
(city) (state)
place or places where I maintain another or other place or ~:aces of abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.)'
! BECAME A RES I OENT ON THE 2ath DAY OF N`ay , 19 ~1 .
Also, my wife, Gwenneth, and my
minor children, Jill, and Jonathan.
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signa ure /
=•.-'=~`:~~ (l2obc2r S_ Pb~c~e[-~-~r~,Gl
'" ~'°'- :; .,: ` GuJ~'1a.~» e t-h '0 . `' ~
~`' ~' ~~.~'f'r~ 26th y February ~ ~ 81
Sw~rn,~t~j~t~~..s~. ,~ ,bed before me this da of A. D. ~ 19 .
~~~ ~~~' ,~ .''~ '= - ROGER PO ! TRA S, CL ERK C I RCU i T COURT
: ~", ,~C~ ST. LIJC ~ E COUNTY, FLOR I DA
No t~- .~ P u i ~ F ori da a t Lar e. •
My E~.~s ' on #~gs ~~ ~K A~~ ~ R~~~ ~ ~~, B Y DE P U T Y C l E R K
;.~ ~- y' ~ ~ i M I11lG . t 7 14a1
FOR DiQ~-S,cIA$~~ STAT~'~ ~ ~E~~~~' FLORIDA :
7 ere y ~ t at my omicile is in the State of and that I intend
to permane't~t2p~'~ontinue 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 caunty of place of abode in Florida.)
.
(Person makinq declaration m~y 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 evidencinq any intention to establish his domicile within the State of Florida.)
1981 E~ ~; 26 P!'. ~ `~B
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518321 ~'F~ ~:F~ ~,.;, _: • ~>'~
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Sworn to and subscribed before me this
*loiary Public ,State of~ Florida at Larqe.
My Commission expires .
day of
, (signature)
, A. D. 19
s^~K 3~9 PacE 1~ •
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