HomeMy WebLinkAbout0005S~IUUi
~/
DECLARATION OF DOMICILE
'ro the Clerk of the Circuit Court (County Comptroller) ST. L UCIE County, Florida.
This is my declaration of domicile in the State of ' ~'~, that I am filinq
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-f ~
~ ~=~~ 1 ~ ~ ~ ~ C~~~~z ,
~7- 7 ~ street an nu er
.i `'l~ 1 ,~ 1 ~ L•~ ~ r r i n ~ C T ~ 1 1r ! c n~ ~~ `. p, ~ ~.
~.... ~ j~ .c:.rlua~ w~iia:t~ ~iat.C C~~ dDOQE' 1
Clt~/
recognize and intend to maintain as my permanent home and, if I maintain 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 principa~ home,
and I intend to continue it permanently as such. Z am, at the time of king this declara-
tion, a bona fide resident of the State of Florida residing at ~[,.C( ', K~
~ , <~ street an num~rr-~
~~ ~ ~ ~~ ~ ~' '~ ~ ~. , in -) ~ • ~ L ~~~ I ~~ County, Florida. I formerly resided at
cit ~- ~~
, -~ ` ._ ,~.. C . ' ~~ 1 ~'L ( cc County, ~ ~ I~'IC~C~ , 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 ~nd ~tate of ~^l otrcr p3ace or p2ace~ af aix~ae.)
BECAME A RES 1 DENT ON THE I~ DAY OF ~jj~k,:r~~'~ 19 '
.
I 9E =~
J
S~rorn to and subscribed before me this ~
':otary Public State of Florida at Large.
""y Commission expires
, ~ - -
~ eY1~.
`~1":~,' .~ ~ ~~: ,,,~~~~~.~: ~~
, ~ :_ : ~ ~,,. r. . ..~
signature ~'~~{'` ,,-s ~ ;~ ~ •
'~s . ~ ~ ' .:
~ ' ` ~C ~b~~~. ~'`•..' ,~ -r
day of , Ac '•~1~
. - •-~ ' ~ ~, =s
_ 'D: ~. .
ROGER POI7RAS, (~~_C'~~RC~#'J~r!EOI~tT
S. L UC I E COUNTY,.~, ~R,~.
~ ~ 'y,~r ; ~~ ~~
~ (L:ACZ~.ti~ ~h'~~.• QE~'UTY CLERK
='OR DOMICILIARIES OF STATES OTHER THAN TNE STATE OF F~R~: ~
~ ereby declare t at my omicile is in the State of ~nd that I intend
~o permanently continue and maintain my domicile in suc state. At the time of making 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,
and county of: place of abode in Florida. )
!Person making declaration may also include such ot~er and further facts with reference to
-~ny acts dcne or performed by such person which such person desires or intends not to be
~:~ns;,rt~ed as evidencing any intention to establish his domicile within the State of Plorida.)
19Ei !~t,~ a 9 P;` 2~ 3~
S~lOU1 ~ ~~EC ~N[ i' Cl~r:li ~,
~~~~~~~~; `r. y- i, f+~,.
f=fG[R ~Ci~""`-'
"l: Fr; ;. r rr `~•' ~
~ _ .. . ~ -
- '- " -
signature
~»orn to and subscribed before me this day of
':otary Pub ic State of Florida at Large.
'~1 Commission expires
A. D. 19
u,?~ 35~ F~l~f 5