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518918
DEt'IARATIO!~ OF DUMICILE
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To t*:e Clerk of the Circuit C.ourt [County cc.:~ptroller) _ ST.. LUC 1 E_ _ County, F2orida.
:ris is m}~ declaration of domicile in the State of r~~~~ , t}at I~r- filing
t.his day in accordance and in conformity wi~h Scction ~2~,1?,~}'loric~a St.a~utes.
=0R UC~yICIL:ARIES OF `iHE STA'TE OF FLORTDA:
I hereby declare that I reside~.a ~nd ~^,aintain a place of abo3e at ~~~ ~ ~~~ ~ t f ~.
~~n~~!?~~ ~street an~ nuR~ec~~
_ ~,, in ____STL l lK 1 E____^ County, Florida, which place of abode I
-- - ~ c i t~- - -- - _ fw . .
~,•co~nize and inte:~d t:o maintain as my permanent hor~e and, if I ~:aintain another place or
~.~laces of abode in so:~e other state ar states, I fiereby declare that r*-y above-describ~ d
:esid~s:ce a~d abode in-the State of Florida constitutes my p.edominant and princiDal '~o~e,
jnd I Sntend to co:~tinue it pei~~an~ntly as such. I am, at the ti of :~~ki~¢ this <ieclara-
'ion, a to:.a fide resident of the State of Floricia resi~iing at ~ i~~~`~ ( LC7 -
straet and num~er-j-
~ RC~,~, in ~j ~~ U~(l= County, Florida. I forr.,erl~ resided at
~ ~ - ~ - -. -.
~~ ~ U~ ~R ~^I ~~ . ~ (~ ~ W~~_~_, County. ~~ v~,~Y_.~.__`_M~• and t~e
(city) . .
::1ace or places where I r.;aintain another or uther place or places of abode are as follos.s.
;:i~re list strPPt ac3dress, city, c~unty and state of any other pIace ar places of abode.)
i 3EC~ME A RESIDEhT CN THE _ lQ__ DAY OF ~~~ ~ 19_~.S .
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~ . ~- .: ~.-r ~signature)
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~-worn to and svbscribed before me this ~ day of ~~t.t.t~ , A. D. 19~.
ROGER FO I TRt~ S, CI_ E~K C I RCU I T COU~ T•
ST. LUC 1 E COUN1"Y, F~C~ i Dp
.-.~ar}~ Pu~lic State of Florica at I,ar~e.
: Co-~.~ission exoires , . BY__~~ ~~~ dEPUTY CIERK
-'-P. BO!!ICILZAP.T_ES OF STATES OT~jER TtiA23 THE STA:'E OF FLORI~A:
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~: :.ereby ceclare that~ my domicile is in the State of and t~:at I intead
_~ per:~a~°.ently contin~se and maintain my domicile in such stare. At ~he ~i--.e of s-aking *`±is
'.~-claration I am a bona fide residFnt of t~e State of . Mv place of
~~~de within the State of Flor~da, if any, is as folle:~: (Fiere,,ist str~et a~dress, city,
,-,3 county o' place o.` abode in Florida.)
.-rson ~*~king declaration ra}• also inc2ude such other and further `acts h•i*_h ref~r~n~e to
^i acts done ar gerforr_d by s~sch pe:son which such pers~n desires or ir.t~^~s not to be •
:.strued as evi~e~cing any intention to establish his domicile within tL.e State of Fl~ri~'a.)
5:1~91b
1981 H~,R - 4 P'' i?~ 1, 3
ct~_r~ ~N ~r~CpDi Q
5'.IUCIE f. MlY.l1 A
rrGE~ r~'itRAs
C~ERit CIrCUi' Cr:~~~;
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-.~~rn to ar.d subscribed before me this
;~ary Public State of Florida at Large.
; Cc~T.,~ission expires .
(signat~re)
day of , A. ~. 19
`lK~49 ~ ~~,E2~57
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