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DECJ.ARAT20N OF DOMICILE ~~
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To_the Clerk of the Circuit Court [County Camptroller) ST. Ll1CIE County, Florfda.
This is my declaration of domicile in the State of ='l~ricl~ , that I am filing
this day in aacordance and in conformity with Section ., F ori a tatutes.
FOR DOMICILIARIES OF THS STATE OF FLORIDA: 1312 I'ari:land
~Y Rlvd.
? hereb}~c3ec2sre that Z~e~fu~ i~i ana maintain a~I$ce at abode at '~ j ,
Ft. Pierce s ree an n er
, in ST. LUC 1 E County, Florida, ~-hich place of abode I
city
rP~ognize and intend to maintain as my permanent home and, if I maintaia another 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 prfncipal haae,
and I intend to continue it permanently as such. I am, at the ~ e of m king th's declara-
tion, a bona fide resident of the State of Florida residinq at z3~ Par~lar~d R~vd. ,
Ft. Pierce St. Lucie street an n r
, in County, Florida. I formerly resided at
~~~pa , ;-lillsborough County, Florida ~ 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.)
~ BECANE A RESI~ENT ON THE r IS OAY OF f AP~14 ~ 19. 6~ .
~our~ry
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~~~'f cour+~'+•~~ signature
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Sworn to and subscribed before me this ~~ day of ,!~. D. 19 D~.
ROGER PO I 1Rp S, CL ERK C i RCU I T COUR T
ST. LUC 1 E COUNTY, FLOR i DA
Notary Pub ic State o F ori a at Large.
My Caminission expires B Y~cA DE P U T tr C L E R K
FOR DOMICILIARIES OF STATES O'FSER TFIAN THE 5TATE OF FIARID~A:
ere y ec are t at my omica.le is in the State of and that Z intend
tc pennanently continue and maintain my domicile in suc state. At t e time of making this
dzclaration 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 ad8ress, city,
and county of place of abode in Florida.)
(Person making declaration may also include such other and further facts with reference to
any acts done or performed by such person which such person desires or intends not to be
construed as evidencinq any intention to establish his domicile within the State of Florida.)
5~0990
~981 KAR t 9 Pt~ 1~ 29 1
FILEC tNt ~~ CGR: CC ~
S1 LUCtE CCtlN1Y.F't A.
f~OG~R POITRl.S
CLfRKCIRGl1t; COURT ~
i
^_ • ~ signature
sworn to and subscribed before me this day of , A. D. 19
~~otary P ic State o F or a at Larqe.
"~y Commission expires .
n~~350 ~~~~2~~$'l
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