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DECLARATZON OF DOMICILE
'ro ttle Clerk of the Circuit Court [County Comptroll~r) ST. LUC 1 E
• 521388
County, Florida.
':his is my declaration of domicile in the State of .-f/~2 ~w , that I am filing
thi~ day in accordance and in conformity with Section ~22.17, F~ oriaa Statutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintailn a place of abode at ~_~ ~, ~~~ Z ~
i c~; { IJ~~t r~ -F , in ST. LUC 1 E County, Florida, whichrplacenof~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 residinq at i2~ j j36~ ~1~, ~
"" ~ "~ ~ ~ , ~ ln j-} , street an num r ~
~. ,r i-t~ County, Florida. I formerly resided at
city - , _
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~CiL~i ~ - ~ ~ ~ ~ ~~,_~ '~' _ ~-'OUDt~r ~ ~ uc ~ f-~ C~ s a~fr~ thss
::iace or places where I maintain another or other place or placesaof abode are as follows:
(xere list street address, city, county and state of any other place or places of abode.)
t3ECAME A RES 1 DENT ON THE ncI OAY OF J `~ t ~ 19_ ls3 ~
• ~ ~
.. J ~ ~
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sworn to and subscribed before me this ~ 3 day of~j`,~
, A. D. 19~.
ROGER POI TRAS, CLERK C IRCU I T COURT
':otary Public State o Florida at Large. ST LUC I E COUNTY, FLOR I DA
My Commission expires BY ~~ - ~EPUTY CLERK
~'OR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
hereby declare t at my domicile is in the State of and that I intend
~o 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
sbode within the State of Florida, if an • My place of
and county of place of abode in Florida.j~ is as follows: Here ist street a8dress, city,
'?erson making declaration may also include such other and further facts with reference to
any acts done or perforn~ed by such person which such person desires or intends not to be
~onstrued as evidencing any intention to establish his domicile within the State of Florida.)
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1931 ~~fi 24 ~11 a= ~s
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signature
~worn to and subscribed before me this day of
, A. D. 19 .
':otary Pub ic State of Florida at Large.
~`y Commission expires
~Q~x351 ~~~ 629