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DEC!.F,RATION OF DOMICILE
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_~~e Clerk of the Circuit Court [C~unty Comptroller] Sj. LUCIE County, Florida.
~ is is my declaration of domicile in the State of •~r<<-ti< << <. , that I am filing
:. : s day in accardance and in conformity with Section 22~, 1~ F~ori~a Statutes.
"r i~1?'lICILIARIES OF THE STATE OF FLORIDA:
..~~: eby deelare that I reside in and rr,aintain a place of abode at ~"'`~~ :%/~c~r :/c~ ~~c<<r .,t~-q,C
. ~'1 ~ ~street an~ n~er) ~
~/ Z~ t_•< < f , in __ ST. L UC I E_____ County, Florida, which place of aboc3e I
(city)
~. ~_nize and intend to ,~,~~ntain as my perrr,anent home and, if I maintain another place or
~_.~_~s of abode in some other state or states, I hereby declare that my above-described
~:?~nce and aboae in the State of Florida constitutes my pzedominant and principal ho;ne, .
~ I intend to cor.tinue it pez-,,anently as such. I am, at the time of nakin thi de~lara-
:_~, a bona fide resident of the State of Florida residing at ;i %~r~~ .:~~/~~~ ~'~z'<</~E<<'«<r/ ,Fl~,,~
~ • (street and nuntber) /
„~ / ~~ r ~ ~ ~ , in _~ ~ < <;- . ~;. County, Florida. I formerly resided at
(city~ ~ ~ _ ; ~-- - -- ,
: t . ~< <{ C ~i cf c~ . ~ - ,~ .. ~, t - County. C ~t c ~ % . ~ -. ,~ . << , and the
~1 -
(city) J (s~ate)
~,::e or places where I maintain another or other place or places of abode are as follows: ~
:=-re list street address, city, county and state of any other place or places of abode.) .
==C:.ME A RESIDENT ON TNE DAY OF
_ .~ _ / ~ ,, t , ~~~~ ,~~ / ~.
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'.. r:a to and subscribed before me this (~
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f_=r}• Public State of Florida at Larae.
, 19 .
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f • ~ .l. z. ~ ! .< •. ~~ ' ~7 ~~/~* Y i' . ' .~~'•~.
(signature) `, ,: ':. '•• :~ -~~
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day of ~JJ~ , A.~ ~=;`', 9~' ~ 1 :.c; : .
` ^~~~~ ` • ''" :: : _
ROGER POI TRt~S, CLE~~'ZC~I~fS:.Z~4URT
ST. LUC 1 E COUNTY, FL'~~Dl~''~ ~~,
.;~-
~;~ C ~:;u ission expires ~. BYc_ ~ - DEPUTY LLERK
~~-~~MICZLIARIES OF STATES OTHER THAN THE STATE OF FL-O~IDA:
j -=-~by declare~that~m}~ domicile is in the State of and that I intend
~. _-_-anently continue and maintain my domicile in such state. At the time of makino this
-,aration I am a bona fi~e resident of the State of My place of
-:e r:ithin the State of Florida, if any, is as follows: ~(Here list street address, city,
~~_^unty of place of abode in Florida.)
~"-_.=~n naking declaration may also include such ather and further facts with reference to _
~._~ _.~ts done or perfozrned by such person which such person desires or intends not to be
~..-_r;:~~ as evidencing any intention to establish his do:nici2e within the State of Florida.)
; S 1va7 V ~~
~98~ MaR '~+ A~~ 1~' 28
t
;~~~-^ to and subscribed before me this
~~r}• Public State of Florida at Larqe.
_ ~-~_<<ission expires .
1;t EC~ ~hC F~ CG~?i~f ~1
' S!. Ll;~ C tCUN?'! I~l A.
1'CG~R i'01 i RAS
CLEf~K CInCU1T COUN.I i
• . .:l ,''; _ ~
(signature)
day of , A. D. 19 .
5~»K 349 ~~~E z232 .