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5~1343
DECLARATION OF DOMICIL~
To the Clerk of the Circuit Court [County Comptroller] ST. L UCIE County, Florida.
This is my declaratiori of domicile in the State of ~~/o ~C,C/A . that I am filinq
thi~ day in accoruance and in coniormity witn section «t.li, r•iorida statutes.
FCR DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at /arj ~ L/tc'~~~~~,~c~Cr~-'~
-~street an n er
~~~ ~ ,~~i C' . in ST. LUC I E 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 this declara-
tion, a bona fide resident of the State of Florida residing at ~~~~,~ L~ ~-<i~,~~.•<~' n~~ .
1 ~ street an num er -
~ c~ ~ ~~~ ~k t E'_ ~ , in 5T. L t.c c~~ County, Florida. I formerly resided at
city ~
,, r ~ m :.: ; c; •~ . ~1/~.~ /-f~ Nt~: ~- County. /1fv .t.: ~. , 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 RESIOENT ON THE
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lG~E CUNN E`oQ
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signature
%~,; r s~ ~l t,~;.~kr~
Sworn to and subscribed before me this ~_3 day of i~!A ~~~, , A. D. 19 ~ ~.
ROGER POf TRAS, CLERK C IRCUI T COURT
ST. LUCIE COUNTY, FLORIOA
':otary Public State of Florida at Large. ~" '
'y?y Commission expires BY ~'`~~"'~'`~-C~ DEPUTY CLERK
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
1 ereby declare t at 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
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.) .
!Ferson 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 dar,iicile within the State of Florida.)
5%~1343
19~f ~il:r 23 t' . t2: t; 3
F ~i = I: thi _: f.i..., , :
~' L~_C;i CC;V;}".f;
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~
signature
Sworn to and subscribed before me this
`~otary Public State of Florida at Large.
'~r Commission expires
~ ~ D A Y 0 F ~~?~i' <'-'~-- ~ 1 9___~ ~__.
day of _ , A. D. 19
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