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5184~0
• DECLARATION OF DOMICILE
o the Clerk of the Circuit Court (County Comptroller) ST. L UCIE County, Florida.
~is is mp declaration of domicile in the State of "~L .~c l~~c~ , that I am filing
~,is day in accordance and in conformity with Section .. , F ori'~Statutes.
~R DOMICILIARIES OF THE STATE OF FLORIDA:
;:ereby declare that I reside in and maintain a place of abode at ~/~/ S',C, /~j -' ~ )~ ~t
~ street an ~n ~er~.~
,.J ' T S~ ~ G Gi~e- , in ST. L UC 1 E County, Florida, which place of abode I
city -
~-coanize and intend to maintain as my permanent home and, if I maintain another place or
?_3~~es 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 pzedominant and principal home,
~~ I intend to continue it perir,anently as such. I am, at the time of making this declara-
_on, a bona fide residrent of the State of Florida residing at 7G/ S. ~ 7/l~nc kS 2 i/ii~c U .
street an num ~-
_ s,_T "~ Lv~.•~t , in J~ L v~-~~- County, Florida. I formerly resi8ed at
city ~::_.~~
---~ l l i' . ~~ /J r~,V ~r CountY. ~/Gr. L/ , and the
cl y - state - ~
',ace or places where I maintain another or other place or places of abode are as follows: i
~~re list street address, city, county and state of any other place or places of abode.) ;
gE CAME A RES i DENT ON THE ,~_ DAY OF ~~'~.,_~~ T ~ 19 ~(~ ,
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.:orn to and subscribed before me this o~, day of ~~ , A. D. 19 ~~ . '
,~
', ~ ROGER PO I TRp S, CL ERK. C I RCU I T COUR T
ST. LIJC I E COUNTY, FLOR i DA
~-_~:y Public State of_Florida at Large. ~1
~; Cc:~Tission expires . BY~s , ~/2~~~ DE PUT Y C l E R K
~
-F. DO^!ICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
:.ereby.declare that my domicile is in the State of and that I intend
-~e:-:.,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 of Florida, if any, is as follows: Here ist street address, city,
~:d c~unty of place of abode in Florida.)
~-=rson making declaration may also include such other and further facts with reference to
;• acts_done or performed by such person which such person desires or intends not to be -
~-.s~rued as evidencing any intention to establish his domicile within the State of Florida.)
; 5184'70
1981 F':c~R -2 '': ~ 22
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~rn to and subscribed before me this
~:tary Pub ic State of Florida at Large.
,~ commission expires
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signature
day of , A. D. 19 .
s~'~349 PMUE1565
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