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DECLARATION OF DOMICILE
'ro tlfe Clerk of the Circuit Court [County Comptroller) ST. L UC I E
'rhis is my declaration of domicile in the State of ~~. ORI LI /-~ , that I
thi~ day in accordance and in cenformity with Section ., F ori a Statutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA:
am filing
I hereby declare that I reside in and maintaih a place of abode at 'Z~~ w~. ERiE ~~.
r t' f%ErP~'E ~ ln street an n er ~
_ S T. L ~X IE County, Florida, which place of abode I
city
recoqnize and intend to maintain as my permanent home and, if I maintain another place or
places of abode in some other state ~r states, I hereby declare that my above-described
residence and abode in the State of Florida constitutes my pre@ominant and principal home,
and I intend to continue it permanently as such. I am, at the time of naking this declara-
tion, a bona fide resident of the State of Florida residing at Zo~, k,~ ~ipj~' ~p
_ 1'~ /~/E~'Cj~' , in S~ . aCll c IC- street an n r ~
County, Florida. I formerly resided at
city ~
~EA 1~~/Y l~.4. . ~'E~i~S County, /Q/~ . , and the
city state
~lace or places where I maintain another or other place or places of abode are as follows:
;xere list street address, city, c~ounty and state of any other place or places of abode.)
R~ ~'~ •~~•k 971 -~PE-'Adi.t'~~/, !~ . ~ 60 7
BECAME A RESIDENT ON THE %-~'" DAY OF9 Se~-~ . Iq ~~1 _
'-~ ~<" r'J • , nn ~c,, . ~ : .
J , ._~_ .
~ (;S ,1~i~ ~~~ G' 4 t~rr,~Qek'~.
signature _ ,, . .
, .
Sworn to and subscribed before me this ~2 5 day of ~'~~ ,, ,~ ~ ~ , A. D. 19~. .
ROGER P01 TRAS, CLERK C IRCUtT COURT
':~tary Public State of F orida at Large.
"'-y Commission expires • . ,
ST. LIJC I E COUNTY, FLOR I OA
BY~,~ . „~ ' '
- [~,ti~~~~d-a-Y1DE P U T Y C L E R K
t'^R DOMZCILIARIES OF STATES OTHER THAN TiiE STATE OF FLORIDA:
:.ereby declare t at my omicile is in the State of and that I intend
to permanently continue and maintain my domicile in suc state. At the time of makinq this
declaration I am a bona fide resident of the State of My p2ace of
~bode within the State of Florida, if any, is as follows: Here ist street address, city,
and county of place of abode in Florida.)
!rerson making declaration may also include such other and fuzther facts with reference to
G:~y acts done or performed 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.) 3
1331 F~f,R 25 PN 12~ 23
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iLlUClf CCil4TY.Fi~•
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5%~160y
signature
"worn to and subscribed before me this day of , A. D. 19
':~tary Public State of Flori a at Large.
,';• Commission expires
' b~J~~l(~5~ PlGE ~~
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County, Florida,