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DECLARATION OF DOMICILE
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o the Clerk of the Circuit Court [County Comptroller~ ST. L UCIE County, Florida.
=~_is is my declaration of domicile in the State of ~~ , ' that I am filing
-;is day in accordance and in conformity with Section 122. , F ori a Statutes.
_ F. :~"'1IC7LIARIES OF THE STATE OF FLORIDA:
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`:~-: eby declare that I reside ~n and maintain a place of abode at%>!'f~ ~/ti.,~
~ 7 . (~reet an n er)
/~ +_., in ST. ~ UC 1 E County, Florida, which place of abode I
` city~ ~ -
~-co.:nize and intend to maintain as my permanent home and, if I maintain another place or ,
laces of abode in some other state or states, I hereby declare that my above-described
~_i~ence and abode in the State of Florida constitutes my predominant and principal home, •
-,c I intend to continue it pex~r,anently as such. I am, at the t'me of aking this d lara-
i o~ , a bona f ide res~ident of the State of ~Florida residinq at ~ ~ ,~_Q /-~ .,.~{~ ;,.
? ,( ,,/ s reet an number)
- _,!~1/,ti ~~ ~'/ ,~~Cc,a« . in ~~• _-~,~.c_t_.~ County, Florida. ~ I fozmerly resided at
/ ~~ ~. + y
~ ~ ' ' County ,~-
~- i L ~ . c-~..r~.t~~,~ , ~ -s-~.~~c_ , and the
-- tcity) • (state) -
':~^e or places where I maintain another or other place or places of abode are as follows: ~
::~re list street ad ress, city, county and state of any other place or places of abode.) ~
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`~E C t,ME A RES ( DENT ON THE ~ DAY OF •_;Z~-C- ~ 19 ~ 7.
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, ~~~`'• •~'. ~~ • 1 ~ sign ~tifre
_ ( Pv~uST~r; mAST~ fsc
i»^rn to and subscribed before me this ~ day of
;_~ar}~ Public State of Florida at Large.
~ :• Cc;:rTission expires .
~~~.~~ . A. D. 19$~ .
ROGER PO I~RA S, CL ERK C 1 RCU i T COtlr2 T
ST. LUC I E COUNTY, FLOR i DA
BY ^ r ~~~_DEPUTY CLERK
~~= D~~ICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
1
j ..e_ eby~ ~decla~e ~that ~my domici~e is in the State of and that I intend
.. -~r.:,anently continue and maintain my domicile in such state. At the time of making this
-~;aration I am a bona fide resident of the State of . My place of
--~e within the State af Florida, if any, is as follows: (Here list street address, city,
-.~ county of place of abode in Florida.)
I=~--son making declaration rnay also include such other and further facts with reference to
~-.=•,~cts done or performed by such person which such person desires or intends not to be
-:sed as evidencinq any intention to establish his domicile within the State of Florida.)
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R(,G'2-A f'~'•' ~~~ `~ ~ ~
CLE~K C: _ _~ '
5184_44
(signature)
;~::n to and subscribed before me this
_a:y Public State of Florida at Large.
Cc^unission expires .
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day of , A. D. 19
"K 349 P~~E 1521
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