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DECLARATION OF DOMICILE ~~~~v
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To the Clerk of the Circuit Court (County Comptrollerj ST. L UCIE County, Florida.
':his iS my declaration of domicile in the State of , that I am filing
~his day in accordance and in conformity wiEh Section ., F ori a Statutes.
L'UR D~MICILZARIES OF THE STATE OF FLORIDA:
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i hereby declare that I reside in and maintain a place of abode at~ f0 1~~,~',~~.
` f~ ~ ~ ~ -(street an umber
1r~~L/" ~ ,S_ ,lj in ST I 1.1C I F County, Florida, which place of abode I
city -~-«.~f'
r~cognize and intend to maintain as my permanent home and, if I maintain another place or
places of abode in some other state or states, I hereby declare that my above-described
r~~sidence 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 t~me of king t is ~d~ej lar~ -
t.ion, a bona fide resident of the State of Florida residing at 3~ O/ /~y~,~-~1•
/ / street an num er
~~~~,f ~j,/~J~n~~ County, Florida. I formerly resided at
_ ty ~
ounty, , and the
city - te
p'_ace or places where I aintain another o ther place or plac of abode are as follows:
!Here list street address, city, county and state of any other lace or places of abode.)
i BECAblE A RESI~ENT QN TNE ~~ ~AY OF ~~G~~t~y, 19~.
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t signaTUre J .,~'' '••,
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S~~.~rn to and subscribed before me this / day of ~it jU ''' ~-~ ~~}{ = ~~
~ j- `K .ie'~~;~'~:1~ -~4 -
ROGER PO i TRk ~~ ~~~ .C,-~~t~'T= C~2T
. Ll1C I E CQt~lq~'Y~,~~ ,OR`I UAM1~y:` -:~~,;~
': :*ary Public State of Florida at Large. ~ 'S,'~~' ' ''~ ~'~' ,~
B ••••••••''D ~PL ~ C L E R K
'~y Commission expires ~ ,~,, fS
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"rOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF F IDA '. '
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~~ereby declare~it a=t my domicile is in the State of and tY:at I intend
*_o permanently continue and maintain my domicile in suc state. At the time of making this
_:~ciaration I am a bona fide resident of the State of My place of
:~o3e within the State of Florida, if.any, is as follows: Here ist street address, city,
-:~d county of place of abode in Florida.)
(=erson making aeclaration may also include suc'~ other and further facts with referer.ce to
~zy acts done or performed by such person which such person desires or intends not to be
_~r:strued as evidencing any intention to establish his domicile within the State of Florida.)
S~04'~8
is~ KaR i s~ i: s7
F~~EO ~k[ R: co-~r~~ ~
Sf.IUCIF CCU!l1Y.Ft A. Q~
ROGER FOITFA5 ~
CIERKC~RCU~T r,[~P~ ~
q; rnor~ ~•; F. ~~;
signature
~,•aorn to and subscribed before me this day of
:~otary Pub ic State of Florida at Large.
My Commission expires
, A. D. 19
a~o~350 ~~~t21~9