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DECLARATION OF DOMICILE ~
To the Clerk of the Circuit Court [County Comptroller) ST. L UCIE County, Florida.
~
This is my declaration of domicile in the State of ~.~t~ , that I am filing
this day in accordance and in conformity wi~h Section ~~'f:~'t, Ffori~8tatutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~f~b9~ ~ui..l~s~i N.~_ .
~ t . street an nu er
~y~, i, '~~_ , in ST. L!!C ! E Co~~nty. Florf~a, which g2ace of abode I
~c ~ --'~«.~ r,'
recogni2e and intend to maintain as my permanent home and, if I maintain another olace or
places of abode in some other state ar'states, I hereby declare that my above-described
residence and abode in the State of Florida constitutes my predominant and principal home,
and I intend to continue it permanently as such. I am, at the time of ma in this declara-
tion, a bona fide resident of the State of Florida residing at `7~IJ .~t~ .d~. .
` _ . ~ street an nd` umbe'r~`--
~/~~y~- ~ in ~~G County, Florida. I formerly resided at
` '~ IL~_ ' ' .~,.~_
~ and the
~.. , ~.~ ~ ~ County, .
city ate
~Iace or pZac s where I:r.3intain anot~er or other place ar p2ac~s df aho3e are as fo22~ws:
{~;ere list street addr2ss,.city, county and state of any other place or places of abode.)
~
BECAMlE A RES I DENT ON THE _~ DAY OF ~~ ~ 19__~~.
~' 7C~ ~ ~.~~~ ~l ~ 1~e~~n ~~~~ p~-~~ ~.~~Z ~ Z y~„~ 2~~yo
- ~' `~'= ~~i~
- - _ t`t~ ~~'ti~TY
,C\.j' ..r..~' C'oG J ~ ~ ` .
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_, <,;~~~;,v ~~, ~RrAN T. Re5 oR~e
Sworn to and subscribed before me this /~~ day of
:otary Public State of Florida at Large.
'~y Commission exoires
^Y~~ , A. D. 19 gt .
ROGER P01 TRAS, CLERK G IRCU I T COIJRT
ST. LUC i E COUNTY, FLOR i Dp
BY_~~~~ G~ _ DEPUTY CIERK
FOR DC>MICILIARIES OF STATES OTHER THAN TIiE STATE OF FLORIDA:
E ., _,a-_~,.:~.-:~ ~::~~.:~
I~-ereby declare that my domicile is in the State of and that Z in:end
to permanently continue and maintain my domicile in suc state. At the time of making this
declaration I am a bona fide resident of the State of My place of
abode within the State of Florida, if any, is as follows: Here ist street address, city,
and county of place of abode in Florida.)
lPerson making declaration may also include such other and further facts with reference to
any acts done or perf~rmed by such person which such oerson desires or intends not to be
:~onstrued as evidencing any intention to establish his damicile witt:in the State of Florida.~
siss~s
~ei NaR ~ i ~s ~~ i s
FILCC RN~ f:.COk~CO
ST.LUCt£ OUNiY.ft d.
• ROGER PQITRAS
CIERK CiRCUi C~
kC~G1'h ~ ~ F1t 1: r -
signature
~•aorn to and subscribed before me this day of
~;otary Pub ic State of Florida at Large.
~iy Ccmmission expires .
A. D. 19
~~ ~K350 ~a~E 85~3