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DECLARATION OF DOMICILE
To the Clerk of the Circuit Co~rt [County Comptroller) ST. L UCIE County, Florida.
This is my declaration of domicile in the State of ~~~1r1 ~ , that I ara filinq
this day in accordance and in conformity wiEh Section ~3 ., F ori a Statutes.
FOR DOMICILIARIES OF THE STATE OF FLOItIDA:
I hereby declare that I reside in and mairitain a piace of abode at 3~~ RI~~QY 1~r. ,
p~r~ , street an nu er
`J' ~' • LU.C~ ~._, in $T ~ L UC i~~ County, Florida, which place of abode I
city ~...~~.' -
recognize and intend to maintain as my permanent ho:~e and, if I maintain another place or
places of abode in some other state ~r states, I hereby declare that my above-~escribed
residence and abode in the State of Florida constitutes my predominant and principal home,
and I intend to continue it permanently as such. I am, at the ti e of ak~'~q thi,~+, declara-
t~~n, a b:,;,a fi3e resideni o= zne State of Florida r~siding at ~~__ t~~ ~l~( W~,~ Ur• ,
, -~~street an~ num er
~~j1~}' ~J~ • ~1 ~, , in J~ ~ - ~U ~ County, Florida. I forr.~erly resided at
_-~cit ~ , . ,~-=»~ %~ •
~pV , ~{p~rr'- ~ County, ~ JS , and the
~~city state
place or places where I maintain another or other place or places of abo are as follows:
{Here list street address, ci~y, county and state of any other place or places of abode.)
BECAME A RESIDENT ON THE ~_ OAY OF Q,{I~C~~ 19_~Q.
Sworn to and subscribed before me this 1$
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ROGER PO 11Rp S,
S~~Ll1C f E COU~
~:otary Pub2ic 5tate of Florida at Lar4e.
~y Commission expires
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:r;::~;.~.,..DF.~'t1TY CLERK
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF'P'~AR~-DA: I
~~ h~by declare that my domicile is in the State of and that I intend
to permanently continue and maintain my domicile in suc state. At the time of making this
~eclaration Z am a bona fide resident of the State of My place of
abode within the State of Florida, if any, is as follows: Iiere ist street address, city,
and county of place of abode in Florida.)
;Person making declaration may also include such other and further facts with reference to
:~y acts done or performed by such person which such person desires or intends not to be
c,~nstrued as evidencinq any intention to establish his domicile within the State of Florida.~
5~U836
;worn to and subscribed before me this
1981 NAR I 8 P~ i~ 38
F1t RMC ~fCURUi G
ST.~ IECQUViY.i'iA_
fiOGFR POTTRIIS _`
CLERK CIRCUIT COUR7 ~0~
r.r r{;~~• :TrtF :~ :t
signature
day of -, A. D. 19
~:otary Pub ic State of Flori a at Large.
My Commission expires
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