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518331 ~
DECLARATION OF DOMICILE
To the Clerk of the Circuit Court (County Comptroller] ST. L UGIE County, Florida.
This is my declaration of domicile in the State of ~GG~~~'i !, ~ , that I am filinq
this day in accordance and in conformity with Section 2~.1'f, Flori~a-3`tatutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA: L-A NC
1 hereb declare that I reside in and maintain a lace of abode at ~lij K_Q__ ~~~• -3~
Y ' p streeti a 8 numDer) ~
~,~~~-G ~/~ , in ST,_LUC I E County, Florida, which place of abode I
(city)
recoqnize and intend to maintain as my permanent home and, if I maintain another p2ace oz
places of abode in some other state or states, I hereby declare that my above-described
residence and abode in the State of Flarida constitutes my predominant and principal hane,
and I intend to continue it permanently as such. I am, at the time of making this declara-
tion, a bona fide resident of the State of Florida resi~dinq at,~j4~,a ~; ,; ly p~/ d/ ~~ ~,~,
j n ' ~ stree an nu r)
/~~~'J r~i~l~ ,~ in ,~~ j/` County, Florida. I formerly resided at
(city) , ~
~~i~~X~l~ . ~~ ~ .,~iTj/ County, __1~ , and the
city / tate)
place or places where I maintain another or other place or places of abode are as follows:
(xere lfst street address, city, county and state of any other place or places of abode.)/~/.~
~ /
( BECANE A RESIDENT ON THE C~ OAY OF ~_/ ~y /U ~ 19 Q/ .
4~ COUNr~ !~/'f ~ ~;
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Sworn to and subscribed before me this ~~ day of ,~ , A. D. 19 ~~.
ROGER POI TRpS, CLERK C IRCU! T COURT
ST. LUCtE COUNTY, FLORfDA
~otary Public State of Florida at Larqe. ~~"~ a..~ DE P u T 1r C l E R K
}• Commission expires . BY i~.~
J _ _ ~~
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
Z ereby dec are t at my omacile is in the State of and that i intend
to permanently continue and maintain my domicile in sucri 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 fuzther 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 damicile within the State of Florida.) -
~
51833~ ~
~~
1981 E`~~~' 27 '' ` 3- ~ L
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CtERK =' ~ -~ n
.,
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- _ ~`- ' . . ~y ., . . ~
~
~worn to and subscribed before me this
~
(signature)
day of , A. D. 19 .
'~otary Public State of Florirla at Larqe.
u;~ Commission expires .
8~'~349 P~~~~351