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5~0820
DECLARATION OF DOMICILE
~~
To the Clerk of the Circuit Court [County Comptroller] ST. L UCIE County, Florida. ~
~ ` ~
'^?:is is my declaration of domicile in the State of ~'\flr~c~cti , that I arn fi2ing ~
this day in accordance and in conformity with Section ., F ori a Statutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~,L.Q ~j ~~er~-Y~~`~,,,,
• street- a~-nur.i e ~'
~~~ ~~ u. ~ , in ST. ~ UCIE County, Florida, which place of abode I
c~ty ..+~,,,.r,.
recoqnize and intend to maintain as my permanent home and, if I maintain anather place 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 ho;,~e,
and Z 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,.\ C~~r~•t~ri~l ~ .
~ ~-~- , ~ , in S-~ , ~,_, ~street an num~er~-
~ ~t~ County, Florida. I formerly resided at
-~ ~city , ~_:_ ~_-~
~`~ ~~o~. ~ C9-e w~eSS County, '(~1~ h , and the
city state ~ '
place or places where I maintain another or other place or places of abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.)
~ 3EC~ME A RESIDENT ON THE ~ 0/1Y OF ~~-C~ ~ 19~.
~wor~ to and subscribed before me this ~ day of
':~tary Public State of Florida at Large.
'~y Commission expir~s ~
M• M~~NTyIZe)
~,~t~2 T 9
~
~ ~
,
CLERK i
:OP. DOMICILIARIES OF STATES OTHER THAN THE STATE OF F~QRI~A: ' `~ '~'~,,~r„'~•'ir,::#•~~;-' _
~ _;..o~. -..:...~.~.s. .., . ; . . , .:
a:e~~by declare t a~i t my domicile is in the State of afiB:~Ghet~ I intend
to permanently continue and maintain my domicile in suc state. At the time of making this
dec3aration Z am a bona fide resident of the State of • My place of
=:bode within the-State of Florida, if any, is as follows: Here ist street address, city,
and county of place of abode in Florida.)
':erson making declaration may also include such other and further facts with reference to
a-:}• acts done or performed by such pe:son which such gerson desires or intenc3s not to be
..~,r.strued as evidencing any intention to establish his domicile within the State of Florida.)
~~~
1981 MAR I 8 1UI I I~ G S
fllfC ~hC'=COk(iLD
S* LllCtE CCUVt~(.fl ~.
RrG.R POITf~A5
ttEaK ciacuiT co~~r
; ~,.~•, ; ; ~•~ ;, .
~~.~•orn to and subscribed before me this
':~tary Pvb ic State of Flori a at Larqe.
"`:y Commission expires
signature
day of
, A. D. 19
BOOK J~ PAGE ~Q~
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