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5~1;341
DECLARATION OF DOMICILE
~ro ine Clerk of the Circuit Court (County Comptroller)
ST. LUC i E County, Florida.
'rnis is my declaration of domicile in the State of , that I am fiiing
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FOR DOMICILIARIES OF THE STATE OF FLORIDA: ~Ct-J .
/~~ J e~<<n,
Z hereby declare that I reside in and maintain a place of abode at ~ti~ S.l.c~.~~,~i.,c.cv.~c- ,
street an n er
, in S T. ~ UCIE 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
r~sidence 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 m in this declara-
tion, a bona fide resident of the State of Florida residing at ~ ~~ Q.~~-• .
~ street an num er
~~; ~~;~~ , in ~Q . County, Flori I form~rly resided at
~ /1 Zc Y ~
_ ~ ~ - .~~~_~ County. . , and the
c ty 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 oX places of abode.)
BECAME A
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J
RESIDENT ON
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- 19~.
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signature C-»~
~worn to and subscribed before me this a-3 day of ~(~~l-~ , A. D. 19 ~~
ROGER P01 TR~S, CLERK C IRCU I T COURT
ST. LUCIE COUNTY, FLORlDA
~:otary Public State of Florida at Large. '
~!;~ Commission expires BY C~:~- :/+~~`~' DE P U T Y C L E R K
rr
POR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
_:~ereby declare t at my domicile is in the State of and that I intend
tc permanently continue and maintain my domicile in suc state. At the time of making this
declaration I am a bona f ide 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.)
;Ferson making declaration may also include such other and further facts with reference to
~~}~ acts done or performed by such person which such pers~n desizes or intends not to be
~^nstrued as evidencing any intention to establish h~s domiciie within the State of Florida.)
I~FI ~:~.~ 23 "r~' 12~ 40
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5~1;341
~•.:orn to and subscribed before me this
':~tary Pub ic State of Florida at Large.
".j Commission expires
signature
day of
A. D. 19 .
~:~'~~351 ~~s~~ 5~4 ~
THE ~ DAY QF