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DECLARATION OF DOMICILE
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To trie Clerk of the Circuit Court [County Comptroller~ ST. Ll1~lE County, Florida.
This is my declaration of domicile in the State of , that I am filing
thi~ 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 maintaih a place of abode at ~9~;,1 A y,rJ j.~ih ,
street and n~er
I~c.-t S~ ~-~c. e , in _ ST. ~UCl~ Cc~.sr.tS, F2~:i3a, ~:hi:.; p~a.:c uL aL~c3e Y
city
recognize and intend to maintain as my permanent home and, if I maintain another place or
olaces of ahode in some other state or states, I hereby declare that my above-descri~ed
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 makinq this declara-
tion, a bona fide resident of the State of Florida residinq at 195~( ,qr.es 6-~~,~ ,
~ street an num r
i~• ~` t S r ~-..~ ' , in S i L, ~ c. ~ County, Florida. I formerly resided at
city ~
-, ~dr. ~~- ~ • C/ ~'fc IN. County, /y, y_ , and the
city state
place or places where I maintain another or other place or places of abode are as foll.ows:
(Here list street address, city, county and state Qf any othez g2acc ar Y2acr~s of at,ade.)
BECANE A RESiDENT ON THE oZO~ DAY OF' ~ICc:•-,b~: ~ jq •_2G ~
_~ .~ n ~,~ ~ ,(J u,,..,,
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~i naturP
, ~~ ~~•,.:.
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s~: orn to and subscribed before me this J~ day of ~(,~(/ , A. =~i~ -3~ ~,~ ~'•~,:: •~ ~
~`~ ~ r~' f• • ~--s'~1t4;e •: ~• ,.
ROGER P01 TRAS, ~~K'~tCL3I~T~ COURT
S. LUC I E COUN~Y .~L OA- ~.~ i- ~
':otary Public State of Florida at Large. `~ .~` .-_; , : ~,• .'.
~:y Commission expires BY `~- DE;~- .Y C L E R K
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POR DOMICILIARIES O£ STATES OTHER THAN THE STATE OF FI.O.LD~ ~~! ~~ '
., ,.~:
0 tI • .
;. ereby declare t at my domicile is in the State of .~~~''~'~~~
and•-that I intend
*_o permanently continue and maintain my domicile in suc state., At the time of.making ttiis
declaration I 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,
a::d county of place of abode in Florida. )
'Ferson making declaration may also i~clude 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
^^.^.str~ed as evidenc:ng any intention to establish his domicile within the State of Plori~a.)
1981 H~R 19 P!~ r 32
~~~O~ll Fi~~C thi F; Ci~~l~: :
cJ.CULIi :GC~'Y.f:'.
,. i?f'G~ R P4! i f71,`•' ~~
. . ~:! ~~:I? Ci. :U`.' r^~
signature
sworn to and subscribed before me this day of
, A. D. 19 .
~:otary Pub ic State of Florida at Large.
";~ Commission expires
~~~x 351 P~~E 4 _
._
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