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5~051'7
DECLARATYON OF DOMICILE
'ro the Clerk of the Circuit Court (County Comptroller) ST. L UCIE
~ /
County, Florida.
ihis is my declaration of domicile in the State of rlorida , that I am filing
`his day in accordance and in conformity with Section ,, F ori a S-atutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at 47 :)e t:ra~'.o ,
street an nu er
_'or~ S~,~,~j~ , ln ST. LUC I E CoLnty, Florida, which place of_ abode I
Zcity .r,,,.~ ~ ..
recognize and intend to maintain as my permanent home and, if I maintain another olace or
places 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 o.f the State of Florida residinq at ~~e~. Pl'ado .
street an m~~r er
_~~ t' , in ~,t. LuCie County, Florida. I formerly resi3ed at
c i ty , C ----t
~~c ~ . "idcilesex County, :•'assaci,~:scl:ts , and t~e
city state
place or places where I maintain another or other pla~e or places of abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.)
( SEC/,ME A RESIDENT QN THE 1~_ OAY OF _iicllCti ~ 19 8~. .
'~ ~~.~~--~~ ~ ~
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Saorn to and subscribed before me this
'.otary Public State of Florida at Large.
yy Commission expires
BY
rOR DOMICILIARIES OF STATES OTHER THAN THE STATE O~f_FLORIi~:
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DEPUTY CLERK
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I ae~eby declare that my domicile is in the State of ? oric3a and that I intend
`o perrr~anently continue and maintain my do?~icile in suc state. At the tir~e of .:.aking t`~is
:eclaratior. I am a bona fide resident of the State of ^ lo~].cia My place of
~~~ode within the State of Florida, if any, is as follows: Here ist street address, city,
~r.d county of place of abode in Florida.)
'?~rson ;r,aking declaration may also include such other and further facts with referen~e to
:.-~y acts done or performed by such person which such person desires or inten8s not to be
~~r.strued as evidencing any intention to establish his dcmicile within the State of Florida.)
5~051'7
f9Bl NAR 16 P~i ~ 24
FILEC ~HC• ~fCOi~f+: A
Si.IUCI~ COUlITY.i! l'..
RCG~'R POlTRAS
CLEFit ClafUtl L^CUQ~ ~
=( „i ~•r: . • - y~~ :
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~worn to and subscribed before me this
`:otary Pub ic State of Florida at Large.
Vy Co~runission expires
(signature) ~~
C~ w; d a A. o~•
•
Gct ~2 t,+._~ a L- o~-1~va'~.
~ day of ,~«~~j ~~~
ROGER POI TRAS,f''
~fi~ L UC I E COUNT
signature
day of , A. D. 19
ao`o~3~ P~~~E2~.0