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DECLARATION OF DOMICILE
To the Clerk of the Circuit Court (County Comptroller•]
ST. LUC I E
/
~
County, Florida.
This is my declaration of domicile in the State of ~~~-'~1 =~ , that I am filing
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FOR DJMICILZARIES OF THE STATE OF FLORIDA:
~ hereby declare that I reside in and maintaih a place of abode at 7G3 .•ni~a .: ~~.t ~
street an nu er
'•~~ t ~~i r~• , 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, Z hereby declare that my above-described
residence and abode in the State of Florida constitutes my:predominant and prir.cipal home,
and I intend to continue it permanently as such. I am, at the ti~ ~f.maki~~ thi~s declara-
tion, a bona fide resident of the State of Florida residing at ~~ nl~:: - 1`.c ,
street an num r
.~..:_ ~i, I~i i .r.E_: . • . _:Ci"..
• , in County, Florida. I formerly resided at
city ~
:•t , County, , and the
city state
~lace or places where I maintain another or other place or places of abode are as follows:
(F~ere list street address, city, county and state of any other place or places of abode.)
.
BECAME A RESI~ENT ON THE ~ DAY OF "' ``~ 19 1.
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.signature '
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~worn to and subscribed before me this ~.5 day of i~/CCYL(~~ , A. D. 19 ~/
ROGER PO I TR~S, CLERK C IRCU I T COURT
_ ST. LUCIE C UNTY, FLORIOA
':~*ary Public State of Florida at Large. ~,}~
M1 Cemmission expirQS . 8 Y cx /'t~,.~~ G ~E P U T Y C L E R K
=0R DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
_.ereby declare t at my domicile is in the State of and that I intend
~e permanently continue and maint~in 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
3bode within the State of Florida, if any, is as follows: Here ist street address, city,
~nd county of place of abode in Florida.)
'?erson making declaration may also include such other and further facts with reference to
a::: acts done or performed by such person which such person desires or intends not to be
~~.^.strued as evidencing any intention to establish his domicile within the State of Florida.)
~~4
1991 HER 23 Pt! ?~ 4~
r~t=C enr tctt,~it:~
S ~. t L'.". li C C U`1 .'. ~G F:;.
`*.C'GER FG!'F..S
~~~ itM ~2: ! ~:11 (''~ ?' ~
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;~worn to and subscribed before me this
'~~tary Pub ic State of Florida at Large.
~'! Coms^ission exgires .
isignature
day of , A. D. 19
~351 ~~.y~~93