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521.;~'"19
DECLARATION OF DOMICILE
To ttfe 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 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~ ~// ~ 5, L_~ ~:{ y~ i~~~' ~/ ~~
; stree an n er
CC~" S~ . in ST. LUC IE County, Florida, which place of abode I
' city
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 principal home,
and I intend to continue it permanently as such. I am, at the time of making thi declara-
tion, a bona fide resident of the State of Florida residing at f~ ~ C'i~ c/> <~ ~,
t, stree an n er
t,S~ ~ L! C% E , in _S't ~,~ ,~~ Co~nty, Florida. .I formerly resided at
city i ~,~
`~ ;3 S ~ ~~r _ '~~. . ~7~, N t o<.- County, N 1~/ ... Y ~, and the
' (T-city state
place or places where I maintain another or other place or places of abode are as ~ollows:
tHere list street address, city, county and state of any other place or places of abode.)
i BECAME A RESiDENT ON THF,~i____ OAY ~OF ~_ ti.' ~ 19 ~~ .
. - ..
' /, ` ~~`~ ' ~. ' {~ ' : .
~ ~~ ~~ 2, t...~,t '~-_~~J~~ ~ .
~ u: % «-~` ' , :~
signature ~"-~- -
( p e rn o~1~' : .~. ~ . . .
Sworn to and subscribed before me this ~l ~_ day of ~}~'~,~,~.~~ , A. D. 19~.
ROGER POI TR~S, CLERK C IRCUI T COURT
ST. LIJC I E COUNTY, FLOR I DA
'.otary Public State o Florida at Large. ~~ 1
My Commission expires Blr~ ~.p.~~ ~,C~„~.rn DE PUT Y C L E R K
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
. ereby declare t at my domici2e 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
declaration Z am a bona fide resident of the State of My place of
abode within the State of Florida, if any, is as followa: Here ist street address, city,
and county of place of abode in Florida.)
'person making declaration may also include 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
construed as evidencing any intention to establish his dcmicile within the State af Florida.)
~~9
1961 MAR 23 AH ;(~ ~;9
iE~~r e~r ~: c~~-~~::.
S1.lUCtF ~CU`:T'I.ii„
ROGER Pr~~ : r,~ ~
CLEEK Clr~~•~i ~r~ -~
. ., _ . ~ i
signature
~worn to and subscribed before me this day of , A. D. 19
':otary Pub ic State of Florida at Lazge.
'f~ Commission expires .
8a x 351 Y~~~ 47~