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DECI.ARATION OF pOMICILE
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_ t~e Clerk of the Circuft Court ~County Comptroller~ ST. L UCIE County, Florida.
:.•:s is m}~ declaration of domicile in the State of ~, that I am filing
~::s day in accordance and in conformity with Section 222.17, Florida Statutes.
_.; :~: MICILIARIES OF THE STATE OF FLORIDA:
~ ~ ~~~/
..- r~by declare that I reside in and maintain a place of abode at '~~ ~v~~ /~SG?r~J~ ICcJ _.
~ ~~~street and number)
__ ~~~ (~ , in ST_ L UC.1 E Cour.~y, Florida, which place of abode I
(city) - -
~_~~_nize and intend to ~raintain as my permanent hone and, if Y maintain another place or
'....-~~s of abode in some other state or states, I hereby declare that my above-described
~-__':~nce and abode in the State of Florida constitutes my predominant and principal home,
.~ I intend to continue it permanently as such. I am, at the time of m ing this decl ra-
f,.^., a bona fide resident of the State of Florida residing at '73(~~~ ~~x;~~,
_,~~...~
' f D~ C~~~ ,P_ , in ~~-. V~! ~,~ _ Covnty, Florida. Itformerly resided at
, . (city ~ J ~-,_--~ •-
> '" (Q ~ t~GC'~~,1 . _ _ Ir~rJ , Q c-~ ~~ ~r~; County, ~- « , and the
(city state ~
'.:~e or places where I maintain another or other place or places of abode are as follows:
:=~~re list street address, city, county and state of any other place or places of abode.)
~EC~ME A RESIDENT ON THE ~r) OAY OF IJ~n _ ~ 19 ~~.
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~~~,•~~ F'c,> ~ (sig a re)
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!»- rr. to and subscribed before me this ~ 7 day of ~t~„~.,Q.~ , A. D.~ 19 a~.
! ROGER P01 TRA $, CL ERK C I RCU I T COUR T
~ ST. Ll1C I E COUNTY, FLOR I OA '
~_-__~y Public State of Florida at Large. yn'
'~ ~_. ^:ission expires . BY ~-;/,~~{-~-y ~EPUTV LIERK
I ~
f"' ~»*!ICILIARIES OF STATES OTNER THAN THE STATE OF FLORIDA:
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., ~... . _,_ ~.• _.
~_.=- _ eby ~ decla~re ~that +my domicile is in the State of and that I intend
!- -~--~nently continue and maintain my domicile in such state. At the time of making this
p_~a-ation I am a bona fide resident of the State of . My place of
~:.-~~e uithin the State of Florida, if any, is as follows: (Here list street address, city,
~- ~_.~::nty of place of abode in Florida. )
~ ~
~ r~aking declaration rr~ay also include such other and further facts with reference to
~. ::c~s done or performed by such person which such person desires or intends not to be
~-.__:ue d as evi dencing any intention to esta b lish his domicile within the State of Florida.) ~
~ 518436 ;
1981 F~~ 27 Fy 3~ I3
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a~_.:r, to and subscribed before me this
~-ary Public State of Florida at Larqe.
~ ~ Co:-;.:,ission expires .
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Cl Ei:-S C ~(:~y,r ~r. - ~ -
•-• e~~i
(signature)
day of , A. D. 19 .
~~~349 r~~E1508
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