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518'769
DECLARATION OF DOMICILE
~/
~-he Clerk of the Circuit Court [County Comptroller~ ST. L UCIE County, Florida.
-:~is is my declaration of domicile in the State of ~ ~~~ ~~ ,*~at I am filing
~::s day in accordance and in conformity with Section 222:Y7,.Florida Statutes.
'F D~MICILIARIES OF THE STATE OF FLORIDA:
~.~•r~by declare that I reside in and maintain a place of abode at ~
r--~ - street an nu r~ ~
~.-~ , , in ST _ L UC I E Connty, Fl orida, which place of abode I
ci y •
~~~~;nize and intend to n~aintain as my perrr~anent home and, if I maintain another place or
:~~es of abode in so:ne 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,
•~c I intend to continue it pern;anently as such. I am, at the time of making th~s ara-
i~n, a bona fide zesident of the State of Florida residinq at ~ `~'~'+ ,
~ ` , street an number
~_ ~, , in - County, F ida. I formerly resided at
_ . y - , - ~..:_ ~. _
` , County, ~, , and the
cl y state)~ -
'a~~ or places where I maintain another or other place or places of abode are as follows:
---:e list street address, city, county and state of any other place or places of abode.)
~~
~_CRNE A RESIOENT ON THE~_ DAY OF ~ 19 ~~.
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__ r. to and subscribed before me this ,~_ day of //[L~ ., A. D~~9fd~~:~ -: f:~~:
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ROGER POI TRAS, CLERK'~~;F~tl1T;:GOURT
' ST. LIIC I E COUNTY, FLOR t`Op"'' '"
~:~ ;: Public State of Fl~ri~a at Larae. +--
i_• C~-Tission expires . BY~ ~ja.~ ~[..~a..~ DE PUT Y C L E R K
i
::~^!ICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
`..~__ F y~eclare that ~my domicile~~~is in the State of ~ and that I intend
E: ~~r-anently continue and maintain my domicile in suc~ta e. t the time of making this
=:aration I am a bona fide resident of the State of ~-t ~ . My place of
~'e within the State of Flarida, if any, is as follows•r~ ere ist street address, city,
-.~ c~unty of place of abode in Florida.) ~
-~on r,~aking dec2aration r::ay also include such other and further facts with reference to
~-.- ~=ts done oz performed by such person which such person desires or intends not to be
~-.~==.:ed a~ evidencing any intention to establish his domicile within the State of Florida.)
518'769
1981 NAR -3 J~{ i I~ 31
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RC6:R t'01 i RAS
CLEJ?K Cf'"~ii CCUR~~
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~~.rn to and subscribed before me this
ary Public State of Flozida at Large.
~ co^zission expires .
` Slg i
day of
~
, A. D. 19 .
B~ax349 Pa~E2l709