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S1966t~ ~-
DECLARATION OF DOMICILE
;o the Clerk of the Circuit Court ~County Comptroller) ST. L UCIE Connty, Florida.
':'~is is my declaration of domicile in the State of ~~(O ~F'i0i~ , that I-am filing
~his da}~ in accordance and in conformity with Sectio-n ~~ .~ ,~Floria-a Statutes.
:+~R Dfl~lICILTARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a nlace of abode at /y99 S•G •1`~fSlayj~t/
~~~ ~ ~ ~ ~ ' street an nu er
d~ ~ c~~ . in ST, l_UC !~r County, Florida, which place of abode I
c i ty _.,~~,,. .
:F-cognize and intend to maintain as my permanent home and, if I maintain another p2ace or
;~laces of abode in some other state or states, I hereby declare that my above-described
:t~sidence and abode in the State of Florida constitutes my predominant and principal ho~e,
~:~d I intend to continue it perrnanently as such. I am, at the time of making this declara-
! ion, a bona fide resident of the State of Florida residing at ~S~ f~ S~' ~i~'~~1e<~ G~,%
f G~r ~~ ~~~~.~ ~ ' street and num r~
__ , in -S Y_ L~ t! <i ~ County, Florida. I formerly resided at
city ~ ~. .;,. ~.,.J,.
r O1/ -- , /~ -~3'i~.~~L1sTFi~'- ('rn~nry, ~ /~/. V ~.,a rt,o
~City~ state ~
~iace or places where I maintain another or other place or places of abode are as follows:
!t?.~re list~street address, city, county and state of any other place or places of abode.)
~F_CANE A RESIDENT ON THE ~~_ DAY OF `J~~ ~]9 ~C~ .
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' ~~ ~~~y~~ ~ C~ A~ eo~~>
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.•: signatu e
~ - ~. , ~~ernw S w C~Arrnl 1>
~.~rn to and subscribed before me this ~~ day of ~l ~,c ~.l _, A. D. 19~.
ROGER PO I TRt~ S, CL ERK C I RCU I T COU~T
_ ST. lUC 1 E COUNTY, FLO4 I DA
':--ary Pablic State of Florida at Large.
'•`;• Co.~~ission e ires Blf ~- ,„
~ ~l~~l,~-4 . .~ {~ t~A,iY~ E P U T Y C L E R K.
~-'F DO'~lICILIARIES OF STATES OTHER THAN THE STATE OF FLdRIDA:
~ --~- w ..~ ~ -..r:as..a. ~_~se:sa = ~~~=~,rr.~csc-.r.~sc~er.~-~z~z.:a::.•ct~-rx-:~
.`.~reby declare that my domicile is in the State of /r'L O h i~A and that I intend
~ pernanently continue and maintain tay domicile in such state. At the time of :~aking this
:~•ciaration I am a bona fide resident of the State of F~Ld 2i.ol~ My place of
~-~3e within the State of Florida, if any, is as follows: Here -st street address, city,
~-:d county of place of abode in Florida.Z
~ U 9 8 s. c ~'~~ s~a ,~ ~~..-, ~-~~+~~ y ~S-~ ~~~ c i c: ~ F~ rl ~3.~ S/s ~~
'~:-son making declaration may also include such other and further facts with reFerence to
_~:~ acts dor.e or performed by such person which such person desires or intends not to be
~--:strued as evidencinq any intention te establish his do;nicile within the State of Florida.)
51966~
1981 NAR 10 PII i2~ ~ 7
F~~EC RNC F~-_coenio
S aOGER POITRAB~
CIER!( CtACUtT CQUR
aF~Cr~ ~~c Fl~i~~ _. ~ ----
signature
"~.:~rn to and subscribed before me this day of , A. D. 19 .
':.*_ary Pub ic State of Florida at Large.
".~ Commission expires .
R 5~(;K'J~ P~~F cJ01
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