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DECLARATION OF DOMICILE
:a the Clerk of the Circuit Court [County Comptroller) ~T. Ll1CIE County, Florida.
This is m} declaration of domicile in the State of ~~, ~~~~fj , that I am filing
:hi~ day in accordance and in cenformity with Section ~2.1'T, oriaa ~tatutes.~~.
F OrZ DOMICILZARIES OF THE STATE OF FLORIDA: ,,- ~~~ ~,~ ,,. f~. ,. ~y~~~~~
i hereby declare that I reside in and maintaih a place of abode at ~:~'z1 -L -%~~'-~ ~~~~ ~ ,
/ ,~ street an nu er
-~ ~'~*_ .~~ C.'~ . in ST . L UC I E County, Florida, which place of abode I
city
-ecoqnize and intend to maintain as my permanent home and, if I'maintain another place or
~laces 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 hame,
a^d I intend to continue it permanently as such. I am, at the timg of makin this declara-
~ion, a bona fide resident of the State of Florida residinq at ~/ ~- _,.'~J' ,
~ -
_ -" 1 ' ,, - street ai1 num er
~.c ~~ , in ~ ff ,-~(~~~~ .- ~ County, Florida. I formerly resided at
- rcityr-- ~
_ ~%'~ ~ L~z ~c~~~' . -L~ ~~~~~ i4 c ~~~-.c.(~ County. ~,~- .~ i ~J~.c~ ~ ,e, , and the
city statv
~lace 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„s-~~~ )
- .,~-, _ ~. •,.
= c' . : ~ '. • ; ::,~
BECAME A RES 1 DENT ON THE /_~ OAY OF /~.~i _ ~ 19 ~~ . ~"~~~'..•~ ~ '..~!-~
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Jti
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( ~~L C ~ a ~! ' ~~'~, ' ~` ~'~ ^ ~' ~ ~ ~ / 4~~ ~ ill- . ~ ~/f _i ~
`~ ~ signature i
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rworn to and subscribed before me this a"5 day of ~aic.e~ , A. D. 19 O~
ROGER PO I TRp S, CL ERK C I RCU I T COl~2 T
__ ST. LUC I E~UNTY, FLOR t Dp
'.~tary Public State o Florida at Large.
'~:• Commission expires BY~~ /)~,~~-~ DE PUT Y C L E R K
~~R DOMICILIARIES OF STATES OTHER THAN TNE STATE OF FLORIDA:
~
:.ereby 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 My place of
abode within the State of Florida, if any, is as follows: Here ist street address, city,
an~? 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 damicile within the State of Florida.)
5%z1~13
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signature
;.:orn to and subscribed before me this day of
'.otary Pub ic State o Flori a at Large.
~';• Commissian expires
3
.e
~
, A. D. 19
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