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S~Obifi6
pECLARATION OF DOMICILE
To the Clerk of the Circuit Court (County ComptrollerJ
ST. LUC I E
(
~
County, Florida.
This is my declaration of domici2e in the State of ~~G+/~/ C~ , that I am filing
this day in accordance and in conformity with Section ~.,Ti~e Statutes.
rOR DO.MICIL;ARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~~(;; ~ .~ v C •
street an n- ums-rT-
~~, ~1Q~ . in ST. ~.UC ( E County, Florida, which place of abode I
ci ty ,.,,,«,,~'
recogni2e and intend to maintain as my pez~anent home and, if I maintain another place or
places of abode in sorne 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 gerr*~anently as such. I am, at the time of rr~aking this declara-
~ ian, a bor.a fi~e resident of the State of Florida residing at //~~ ~j~~n Q, 2. .
' street an num r
~~. l~ `~ , in ~a . Lv~l ~ County, Florida. I fo~ ly resided at
city . . J --
~C-~~~~a ~~j -= t1 , ~ ~ ~ F County, ~i ~~,., ~.~-c~ ~ , and the
(c ti y state
glace or places ~here I maintain another or other place or places of abode are as follows:
(Here list street address, city, county and sta~e of any other place or places of abode.;
3ECAME A RESI OENT ON THE ~~ DAV OF ~'~ ~ 19~U . - --
Saorn to and subscri~~1 l~ofnrA ~,e ~~;.~ ~~
':o~ary Public State of Flori~a at Large.
"".y Coaunission expires
PUTY CIERK
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLOR~~C: i
~: ae~~by ~eclare that a-y domicile is in the State of and t2:at I intend
*c pessr.anently continue and maintain my domicile in such state. At the ti~ne o€ ~aking this
~eclaration I am a bona fide resident of the State of My place of
abode within the State of Florida, if any, is as follows: Here ist street address, city,
ar.3 county of place of abode in Florida.)
"~erson ~raking declaration r.~ay a2so include such other and further facts with reference to
_^y acts dor.e or perfor;.-ed by such person which such person desires or intends not to be
~_~:-:strue3 as eviaencing any intention to establish his domicile vithin the 5tate of Florida.)
~~ ~ ~~~
~~ ~ ~ $ ~ ~ 57
ftt~C ~k~ °~~ORDE 0
S RGG£R PGI«~S~
CIERK ClRCUit COU~1 ~
w~rr}Fil\~IS"~~G•--- -~
=~»orn to and subscribed before me this
`~o*_ary Pub ic State of Florida at Larqe.
~; Comr.~ission expires
, signature
day of , A. D. ~9
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D. I~~.
,
C l RCU i T COU2 T
OR i DA
ROGER POI TRAS, CLER
ST~I.UC I E COUNTY, F