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DECLARATION OF DOMICILE
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~ o trie Clerk of' the Circuit Court (County Comptroller) ST. LUC 1 E
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County, Florida.
This is my declaration of domicile in the State of , that I.am fi2ing
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~'OR DOMICILIARIES OF THE STATE OF FLORIDA:
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1 hereby declare that I reside in and maintailn a place of abode at ,
~ street an nu er
) G/U.S~ N ~G~Lt} , in _ ST. LUC I E County, Florida, which place of abode I
city
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 / D ¢/ D R-~A .
Nurchi Nsc~. zstn~:Q fla~. qcs
,~ FN,rt N/ S~~4-L{-/ , in street an n r
-si ~ L!1 C/~ County, Florida. Z formerly resided at
c~ty ~3yr% ~
~ ~S% C/~4-/L_LL'•~, ,~i~iy/~ County, ~ ~ ..~~~/pi f' , 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.) ,
BECAME A RESI DENT ON THE ~~ OAY OF DGG • ~ 19~~ . '
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sworn to and subscribed before me this .-~?G~ day of d~tau.c.IL , A. D. 19 c~~ .
. ROGER PO I TRA S, CLERK C I RCU I T COURT
_ ST. LUC I E COUNTY, FLOR i DA
':~tary Public State of Florida at Large. ~,, ;
".y Commission expires Blr_~,1., U/~.ccC-~~ DE PUT Y C L E R K
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FOR DOMICILIARIES OF STATES OTNER THAN THE STATE OF FLORIDA:
..ere y eclare t at my domicile is in the State of and that I intend
*_o permanent2y continue and maintain mp domicile in suc state. At the time of making this
~?e~iaration 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,
a-~d county of place of abode in Florida.)
'Person making declaration may also inciude such other and further facts with reference to
any acts done or performed by such person which such persQn desires or intends not to be
c:~nstrued as evidencing any intention to establish,his domicile within the State of Florida.)
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:=worn to and subscribed before me this
':otary Pub ic State o Flori a at Large.
`'r Commission expires
signature
day of , A. D. 19
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