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5194~5 ~ ~
DECLARATION OF DaMICILE
~;o the Clerk of the Circuit Court [County C~mptroller) ST. L UCIE y County, Flori~a.
•:his is my declaration of domicile in the State of :i J~ 1__L ~('A~ , that I am filing
this day in accordance and in conformity with Section ~23.f ,7 F1oriTa Statutes.
:CR D0~7ICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and r~aintain a place of abode at `~~Q~•5_,.,~k~`S'j .
street an nu n~~er~
~~ ~~p~,c~ , in ST, t_ UC (~_ County, Florida, which place of abode I
~city -~«.~f.
:-ecoqnize and intend to maintain as my permanent home and, if I maintain another place or
~2aces of abode in some other state or states, I hereby declare that my above-described
:esidence and abode in the State of Florida constitutes my predominant and principal ho,^~e,
~nd I intend to continue it permanently as such, I am, at the time of makirg this declara-
t~^n, a bena f~de resident of the State of Florida residing at fQ~~~,s',,,~~yZh~'~- - ,
street an num er
_~ ~~p,~s ~ , in ~'~,l,~,r,r ~ County, Florida. I fo"rmerly resided at
- . ~ci~- , t--=. „ :._t
~.l~r!' ' . ,~'(Q~,~~•L~ County, ~/f~//' , and t~e
city state
j~lace or places where I maintain another or other place or places of abode are ~s follows:
(?iere list street address, city, county and state of any other place or p2aces of abode.)
! :3ECAME A RESIDENT ON THE ~ DAY OF /U ~ 19 ~~.
/
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signature ,~~~~ '~~.
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~-~orn to and subscribed before me this ~ day of , A; .~. _9~. ~;~. :.~-, _.
ROGER PO I TRA S, E .C ~RCl1~ T= GOl12T
LUC I E COUNTIi~' ~ OR I DA'~ .~~
':-~ary Public State of Florida at Lar~e. .-~;.'-•.,,_ •~'~.~~ ~
'~y Commission expires Blf '4 '' (~EPUTV~ CLERK
_ . ~_ ;~ .
=,R DO!~IICILIARIES OF STATES OTHER THAN THE STATE OF ~FLO~DA: ~
cV_~.: :~. - ~~eak,wc.:ss3c:eazra.-~ar~e~.-a~.caa~rse+arr.-,~.~~az~¢~-•~~,a~
~`,~reby declare that my domicile is in the State of and that I intend
_o pern:anently continue and maintain my domicile in such state. At the time of making this
~.--claration I am a bona fide resident of the State of My place of
;`~~de within the State of Florida, if any, is as follows: Here ist street address, city,
_Ynd county of place of abode in Florida.)
-~-son making declaration may also ir~clude s~ch other and further facts with reference to
..;• acts done or performed by such person which such person @esires or intends not to be
-c~~~n~ ~~ ~.ia~~~~~e~ ` ~.. •-.~.1' 1, ` .i...~: '1 •aL• ~i~ e~ ~ t •
--.. ~- ~'~ .~ u•iJ iTi ~iatiZ'iia ~v i=~a.nuti$ii i7i4'J ulntllLil~ willlllfl I.IIC J~.A~.C~ ~JL ~1V~~~~a• ~
519485
19~ MAR -9 A~! ~ G 3
='~.:~rn to and subscribed before me this day of
`:~*_ary Pub ic State_o Flori a at Large.
'•'.}~ Cornr~ission expires .
signature
fILEG RNC ~ECOROCO
Si.LUC1E COUMTY.FI J-.
HOGER POITRA5
CIERK CIRCUIt CGUR
-fCf:RA .t F:f,i : ~ --- -
, A. D. 19 .
~~`~350 P~~~ 2~0