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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 ,~,,~~c, ~ , that I am filing
thi~ day in accordance and in conformity with Sectio~'f ., F ori a~Statutes.
FOR DQMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~~ ~.~ ~~ ,
street a~ nu er
~,~ _~~_ • , in _ ST. L UC ~ E C~unty, Florida, which place of abode I
cityS
recognize and intend to maintain as my permanent home and, if I maintain another place oz
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 permanentl}• as su:.h. I am, at the time of making this declara-
tion, a bona fide resident of the State of Florida residing at ~ 7~' ,
~ 7street num er
~,~~ -~'~~~-'~~--~ , in ~, ~ County, Florida. I formerly resided at
'~ ~city ~
~(,C~z~G~~U . - ~ County, ' y~~n-fl-~~ , and the
city state
place or places wriere I maintain anoth 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 RES 1 DENT ON THE .~~L~ DAY OF ~~a-LCJ'~ 19~_.
Sworn to and subscribed before me this ~
~:otary Public State of Florida at Large.
":y Commission expires
~''~ ~~ h l q 11r ~ ;,~•.. , :.:I :. ,~'~
7 `~~ai ~Tj:1 c -• ;_ /ri
day Of l~ , ~ A. j~t .Z`•,• ~•~• ~ rr~~•
2 ~ . ~-
ROGER PO I TRA S, Cl„~ft~ "-;; I RCU I T~URT
SF.~UC I E COUNTY~ ~Fi~ i DA .`f ~_
BY
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF F~ORZD~(:
_ r,
'~~~`' Q6P(~TY.GlERK
•_ `~~`~:.:.. . .
• ._~
Z ereby declare t at my omicile is in the State of and t~at I intend
~o permanently continue and a:aintain my domicile in suc state. At the time of making this
declaration 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 other and further €acts with reference ta
ar.y acts done or performed by such person which such person desires or intends not to be .'
~onstrued as evidencing any intention to establish his domicile within the State of Florida.)
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19~1 M"R 23 ~~~~ 3- ~ ~
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CLEFilCI"C7', `~ ~'•'~
, ~. ~ ~
:xorn to and subscribed before me this
~:otary Pub ic State of Florida at Large.
'•`y Commission expires
;
- ~
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1 1 ~- ,~~~, 1
signatLre
r
signature .
day of , A. D. 19
,
n;;~~51 ~~A~~E 45?