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DECLARATION OF DOMICZLE
To the Clerk of the Circuit Court [County Comptroller~ ST. ~ UCIE County, ~iurida.
This is my declaration of domicile in the State of ~uj ~t~~ , that I am filing
thi~ day in accordance and in conformity with Section ~~~.T ,T- FToriTa Statutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintai7- a place of abode at /~ 1 a 5~~,~.UR~S~~
~ t ~ L ~ • ~. -Tstreet an nu er ~
r~ T Si uC ~ , ln ST. LUC i E County, Florida, which place of ahode 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 r.-y predominant and principal hor.;e,
and I intend to continue it permanently as such. I ar,~, at the time of making this declara-
tion, a bona fide resider:t of the State of Florida residing at / o~ 7l S= F« Q~$]~~. ~QQ ,
~ • stree't an nu r
y'~ r~ ST. L ~ , in S T. L U~. ~ c County, Florida. I formerly resided at
city ~ ~
~ , j~ 2. L ~ rU~T V/V County, (J ((Z Ps ~ I1J ~~} , and the
city sta*_e
place or places where I maintain anothez or other p~ace or places of abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.) vl~
aECAME A RESI DENT ON THE a 3' OAY Of ~IQ(ZC-t~ ~ 19 ~~.
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-~ signature .
Sworn to and subscribed before me this a3 day of
`:otary Public State of Florida at Large.
My Commission expires
/~1Ct~-Cf- , A. D. 19 ~ ~
ROGER P01 TR~S, CLERK C IRCU I T COU'r2T
ST. LUC i E COUNTY, FLOR I DA
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B Y~~{ ~"~~~-c_. DE P U T Y C L E R K
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FGR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
. ereby declare that 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~clara~ion 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 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 domicile within the State of Florida.)
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~»•orn to and subscribed before me this
.:~tary Pub ic State of Florida at Large.
"!J Commission expires
signature
day of , A. D. 19
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