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! DECLARATION OF DOMICILE ,
mc ttte Clerk of the Circuit Court (County Comptroller) ST. L UCIE County, Florida.
This is my declaration of domicile in the State of ~~- J~` ~!~ ~ , that I am f iling
_~ _e.,,....: ~.. ._,; ~~. co~~; nn F ori a StatuteS.
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tnls Day u~ a~~~i.:a;.~~ ~:.~ ~.. ..,..._.._...--, ==--== - -
FOR DOMICILZARIES OF THE STATE OF FLORIDA:
Z hereby declare that I reside in and maintaih a place of abode at.S ~~- ~ O~~ p~ ,
street an nu e~
t ~:~~T ST. ~ U G l t , 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 mal~ipg this declara-
tion, a bona fide resident of the State of Florida residing at 5 E L ~~~1 O 2/e ~' ~ .
street an nu r
;'~ ~~ S~ , L.~ /~~ ~, , in ST. L ~J C~ E County, Florida. I formerly resided at
•~.;' ~/v' ~ C R lty A K t . ~~C ~'~ ~/L'!~ Y County, ~ L L! ic,~ U!$~, 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 o: any other place or places of abode.)
BEC~.ME A RESIDENT ON THE ~~R~ DAY OF /"~AIE~C-H ~]9 ~l •
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Sworn to and subscribed before me this ~3 day of l(~~~ A. D. '•~9~ f.
. ~ ~ ,. ~ .
ROGER POI TRAS, CLERK CTR~IJI i COURT
ST. LUC i E COUNTY, FLOR I Dp
~:ota Public State of Florida at Large. ~ ~OE PUT Y C L E R K
!~y Co ission expires BY ~'""" ~~-~
FOF. DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
.ereby declare t at my domicile is in the State of and that I intend
co permanently continue and maintain my domicile in suc state. At the time of making this
~eclaration I am a bona fide resident of the State of . My place of
a~~de within the State of Florida, if any, is as follows: Here ist street address, city,
and county of place of abode in Florida.)
'?erson making declaration may also i~clude such other and further facts with reference to
a^l acts done oz performed by such person which such person desires or intends not to be
_~^~*_rued as evidencing any intention to esta~lish his domicile within the State of Florida.)
. 52136'7
~ 1931 N,~-; 23 F~; :3~ 02
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~ signature ,
~~.~orn to and subscribed before me this day of , A. D. 19
~:~tary Pub ic State of Florida at Large.
~'y Ccmmission expires
~~k 3~ ~ Pa,~ 597 _
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