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DECLARATION OF DUMiCILE
_~ the Clerk af the Circuit Court [County Comptroiler] ST. L UCIE County, F2orida.
:;.is is m~- declaration of domicile in the State of f C c> !~ ~ v/.' , that I am filing
-~is day in accordance and in conformity with Section ., F ori a Statutes.
~~R DO~IICILIARIES OF THE STATE OF FLORYDA:
~ hereby declare that I reside in and maintain a place of abode at :_~? ~ I S w- ~ i~A'i ~~: ~-. ~~ y~~~,
street an num er
/ ~~ 7~S ;, ~ u C ic- , in ST. ~LUC I~ County, Florida, which place• of abode I
czty
:-ecognize and intend to maintain as my permanent home and, if I mainta.::n another place or
~Iaces of abode in some other state or states, Z hereby declare that n} ahove-described
residence and abode in the State of Florida constitutes my predominant ar.d principal home,
a.^.d I intend to continue i~ permanently as such. I am, at the time o~ making this declara-
:ion, a bona fide resi3ent of the State of Florida residinq at ~ a/ s• ~-s :.~f,i ~ ~...: ~= N ~-;
street an nu,~~Ler
!~_ ;? ~~J-. ~ u c' •~ , in J,-~ ~c, t~c- County, Florida. I formerly resided at
" city ~ ~/ ~
~ C?i S:7 ~ ir ~ l~-, /~ ~- c_ ~~. County, ti c;- w / a:'_ h , and the
city state
~,lace or places where I maintain another or other place or ~laces of abode are as follous:
;Here list street address, city, county and state of any other place ar piaces of abode.)
°ECAtytE A RE51 DENT ON THE '~~~ DAY OF ~~~" t' ~ 19 ~% y .
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Sworn to and subscribed befare me this `~_~ ^ day of , l"'[ .' .. ~~~= ~9Y_` r,:'
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ROGER POI TR~S, G~~;~,;~0~1~T COURT
ST ^ L13~ i E COUNTY, ~~.OR ! 0 •
'.ot~ry Public State o Florida at Large. \
My Commission expires B Y ~~~_ Cl' DE P U T Y C z E R K
FOR DOMICILIARIES OF STATES OTHER TSAN THE STATE OF FLORIf)Ac-~ ~
I 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
declaration I am a bona f~3e resident of the State of _ My place of
abode within the State of Florida, if any, is as follows: Her~ Tist a=reet address, city,
and county of place of abode in Florida.)
'Person making declaration may also include such other and further iacts with reference to
any acts done or performe8 by such person which such person des~res oz intends not to be
construed as evidencing any intention to establish his domicile --:~thin the State of Fl~rida.)
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signat;ire ~
Sworn to and subscribed before me this day of
?+otary Pub2ic State of Florida at Large.
~1y Commission expires
R. ~. 19
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