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518498
DECLARATION OF DOMICILE
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To the Clerk of the Circuit Court [County Comptroller] ST. Ll1CIE County, Florida.
This is my declaration of domicile in the State of ~~L a~? / D A- , that I am fflinq
this day in accordance and in conformity With Section ., F or a Statutes.
FOR DOMICILII-RIES OF THE STATE OF FLORIDA:
1 hereby declare that I reside in and maintain a plnce of abode at ~.S /G1 A R lIN .
V ti~ /1! T V R~~ stre~t an~' n er
~ F M S O N/~3 C i1 , in ST,~,~UC 1~ County, Florida, which place of abode I
c ty
recoqnize and intend to mainta in as my perman~n t home and, if I maintain another place 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 hane.
and i fntend to continue it permanently as such. I am, at the time of makinq this declara-
tion, a bona fide resident of the State of Florida resfdinq at 7 2 5"~ _ F 3
4 r• ~„ U G l F. stFeet an n er
J"L-- N S FK B E,ItGft , in County, Florida. I o~ resided at
Ccity)
Fj ~ , w A~[al E County, M t L/~ , and the
c ty (state~
place or places Where I maintain another or other place or places of abode are as follows:
(Here list.street address, city, county and state of any other place or places of abode.)
J - ~~J' ~
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Sworn to and subscribed before me this: day of . , A. D. 19~ .
ROGER PO I 7RA S, CL ERK C I RCU I T COUR T j
-' ST. Ll1G I E COUNTY, FLOR I OA
Notary PubYic State o~~Yorida at Larqe.
My Commission expires . ~ ~ ~ BY DE P U T Y C ~ E Et K ~
FOR DOMICILIARZES OF STATES OTHER THAN THE TATE OF FLORIOA: ~ .
er y ec are t at my omicile s in the State of ~- ~ R~ A A and that I intend
to penaanently continue and maintain my domicile in suct- tate. At trie time of making this
declaration I am a bona fide resident of the State of ~~ a R i D ~+ . My place of
abode within the State of Florida, if any, is as follows: CHere list street a8dress, city,
~.,~v vs_~rrl-u~~~ .r-rrvsFC~,~fick
and county of place of abode in Florida. )"j ,2 3 Ma n
!person making declaration may 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 evidencing any intention to establish his domicile vithin the State of Florida.) ~
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Nof r' efe of Flor;de at Largs signature)
My .~mmissi+on E~pires Jen. 23, 1983
sw o and subscribed before me this ~(~ ~ay of'~T~P ~ , A. D. 19 ~~.
orn t
r~otary Pu~lic State o~ Florida at Large.
My Commission expfres .
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