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DECLARATION OF DOMICILE
~~
~: the Clerk of the Circuit Court [County Comptroller) ST. L UCIE County, Florida.
'~~s is my declaration of domicile in the State of ~ , that I am filing
~ '
~:is day in accozdance and in conformity w•ith Section 223. , Flori a Statutes.
~`R I~O!~fICILIARIES OF TNE STATE OF FLORIDA:
;::-reby declare that I reside in and maintain a place of aboae at ~~ C/~/(~O - ~~
; - ~ '/ stre t and number) '
/~_ S/' ~ U C/ E, in $T„ ~(~ ~~ County, Florida, which place of abode I
(city) - ~
~~c~~nize and intend to maintain as my permanent home and, if I maintain another place or ~
:.yces of abo3e in some other state or states, I hereby declare that my above-described
~=.icence and abode in the State of Florida constitutes my predominant and principal home,
-:c I intend to continue it perrr.anently as such. I am, at the time of makin t~cla,r,~~
i~~nT a bona fide resident of the State of Florida residing at _~~ i
p/ street" num r ~
~ ~ 1` /- ~~ L//L/E, in S~ L, L/C / F County, Florida. I formerly resided at
~ . (city) ~~ . ~:, .... .y
1~_! ~' / S .
.~-~~~ -L( F I~,~ County, , and the
city (state) - '
'ace or places where I maintain another or other place or places of abode are as foll~ows: j
':ere list street address, city, county and sta of any other place or places of abode.) ;
~~E C~ME A RES I ~ENT aN THE ~3d ~AY OF ' ~ 19~~.
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~ ~: n to and subsctibed before me this a~ day of ~''np~,~~ ~ .
, A. D. 19 g ~ .
ROGER PO I TRA S, CL ERK C I RCU I T COUR T
ST. Ll1C I E COUNTY, FLOR I DA
';=~ar}' Public Sta*_e of Florida at Large.
~;• Co~.mission expires . BY~,~a, ~EPUTY CLERK
!-~ DO!~!ICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
~ ~
..~reby declare that~~my domicile~is in the State of and that I intend
_~er,nanently continue and maintain my domicile in such state. At the time of making this
=~.aration I ain a bona fide resident of~the State of My place of
~~e within the State of Florida, if any, is as follows: (Here list street address, city,
.. ~~unty of place of abode in Florida.) '
#---=on a~aking declaration may also include such other and further facts with reference to
E-.:-_~cts done or performed by such person which such person desires or intends not to be- ~
~ r;:ed as evidencing any intention to establish his domicile within the State of Florida.)
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19$I NAR -2 AF; Ii~ 42
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(siqnature)
~._~rn to and subscribed before me this
~ tary Public State of Florida at Larqe.
~ • Co:^r:ission expires ~ .
day of , A. D. 19
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