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DECLARATION OF AOMICILE
To the Clerk of the Circuit Court [County ComptrollerJ ST. L UCtE County, F2orida.
This is my declaration of domicile in the State of ~ ~v.~.,;(c~ , that I am fi:ing
thi~ day in accordance and in conformity with Seczion 2~~i , F ori a Statutes.
FOR DOMICILIARIES OF THE STATE OF FLOR2~A:
I hereby declare that I reside in and maintaih a place of abode at ~f{ ~ lr'~`_-~ ~
~~ ~ street an nu. er
~ ~f ~ C'~_, . in ST I IK' iF' r~„nr., FinriAa ...~:`~ ,_ < <_~ .
clty - - - • • - ..•, .• ~•~•..C~ va Fau~u~ a
recoqnize 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 principal home,
and I intend to continue it permanently as such. I am, at the time of making this declara-
tion, a bona fide resident of the State of Florida residing at t-C~1 `~ (+-~ ~.~# ,
` street an nu r
j ~ ~ "~' ~~` . in ~ ' { '- ~~ _ ~ County, Florida. I formerly resided at
city ~ ~
~_~ , ~ ~ .,, ~~.t~_~c~ ~
iS t« _.-~ ~~~_i . C 1 . County. (_, ~:. ~ -~ , ~ , and the
city st te
place or places where I maintain another or other place or places of abode are as follows:
(Here I1SL street address, C1LY, COt1fltV and Ste3te nf ~ny nthor nl n.~o ~` ..t ~.. c -...a ~
- r-..~.. r~.~..~5 O. 3...~...C.~
~
BECAHE A RESIDENT ON THE ~, DAY Oi' ~~t-~'"'~'~~~- 19 I~j
~ .
~/ ` { r-
_:~_: ._ , { 7 ~ , 1....i `~ ~~i;~ ~. ~• ~ ,
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...,.t,,,, - ~ , ~ , ~ i ~
~~~,n'•.~~~~'~~~~ qs' nature
t i~1 M '1VA . ~ ~ AN
f~fvl l1/ i0-~ • '~Itd+ ~
Sworn *o= `ad' ~i~b~C~£ before me this day of Lj,q L.~, , A. D. 19~.
. a ~ ~~ ~ ~ ~
'~:f'' • -~. ~. • ~.• ~w = - ROGER PO I TR~S CL RK
.~. .,.,_ ~~ , E C IRCUI T COURT
ST. LUC I E COUNTY, FLOR ! DA
'~ot „$~~ ~~ F orida at Lar e. p
. .. . -
Ml~ C~~ ~ ~~S - ~~I~-(1~ BY DEPUTY CLERK
~:~~ „~~ui '
F_nR DOMICILIAR OF STATES, OTHER ,THA1J TNE STATE pF FLORIDA :
:.ereby declar t at 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
d~claration 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,d county of place af abode in Florida.)
'Person making declaration may also include such other and further facts with reference to
any acts done or performed by su~h person which such person desires oz intends not to be
~:;~n~truer3 as evidencing any intention to establish his doa:icile within the State of Florida.)
• ~J~~~l~
ts~! 1'~q 19 '"; ~: 3~
` '1"~; ti,ft-~1 t~' j`1 .
~~:~ c~_ ~~ ~ - _ ~
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signature
. ~
~worn to a~sd subscribed before me this day of , A. D. 19 .
':otary Pub ic State of Flori a at Large.
'ay Commission expires , .
~~,~x 35~ F~~~E 6