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DECLARATION OF DOMICILE
To the Clerk of the Circuit Court (County Comptroller)
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ST. ~UC I E County, Florida.
~his is my declaration of domicile in the State of __~LO~Lt ~/~ , that I am filina
~i~is oay in accoraance anci in conrormity with Section 222.17, Florida Statutes.
~'OR DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a p:ace of abode at 3 g~0 5~ A~ o S
street an nu er~-'~
rD+l~.~- ~r ~'kc~r , in ST. (_UC~~ County, Florida, which place of abode I
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recognize and intend to maintain as my permanent home and, if I maintain another olace or
olaces of abode in some other state or 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 making this declara-
tion, a bona fide resident of the State of Florida residing at 3~i Lo ~-.~G oS ,
" ' street an num er
1p,n,t ~T~ `~iC-ii_ ~ in Sr Lkcc~ County, Florida. I formerly resided at
city ,
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' ~5 ~1.WtSa.~ ~`~=+=r ~ I~.~i-..~ Y.~M~ ~tt'`7 Count ~F
- Y. -~ `~o~~ , ~nd the
city state
place or pZaces where I maintain another or other place or places of abode are as follows:
(iiere list street address, city, county and state of any other place or places of abode.)
BECAME A RESIDENT ON THE ~r~ DAY OF ~'~0~E=~,~` ~ ~q f'3I ~
~4, ~° ~NTY ~~~ o r< <~ j
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j~'~'~~~titY't~ signature
Sworn to and subscribed before me this ~ day
'.~tary Public State of Florida at Large.
'"y Commission expires
of , A. D. 19~.
ROGER PO I TRA S, CL ERK C I RCU I T COl1~T
ST. LUC I E COUNTY, fLOR 1 DA
BY OEPUTY CIERK
FJR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
t .".v•°-••+~.41>:CS.f~~.-+rflY•iiSi" ..i71/i~4iY~~Y'.16~~~
I~~ereby declare tt;at my domicile is in the State of and that I intend
to permanently continue and maintain my domicile in such state. At the time of Taking this
declaration I am a bona fide resident of the State of ~ My place of
a~ode withiri the State of Florida, if any, is as follcws: Here ist street address, city,
~:,d county of place of abode in Florida.)
;r~rson maiing declaration may also include such other and further facts with reference to
::y acts cone or performed by such person which such person desires or intends not to be
c~r.strued as evidencing any intention to establish his domicile within the State of Plorida.)
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19~ NAR I I P~I 2= 32
FILEC ~NC F~CORCEQ
S ROGER POITRASa ~~~
CLE~R CIRLIlI1 COURT
~ ~ t~`. `~ . Srqtf~ture
S::orn to and subscribed before me this day of
'~otary Pub ic State of Flor da at Large.
'~y Commission expires .
A. D. 19
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