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DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller] ST. L UC'IE
County, Florida.
This is my declaration of domicile in the State of -~~t--~-~ ~ , that I am filing
this day in accordance and in confazmity with Section~'~~.I~ F or-T~ida 3`tatutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA:
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I hereby declare~ that I reside in and maintain a place of abode at ~ S S/~u-+~ '~'~-d~~'' ,
? G -~'treet n nu er
J"~-~-~1" .~' 4~-wc-~_ , in ST. LUC I E County, Florida, which place of abode I
city
recognize and intend to maintain as my permanent home and, if Z maintain another place or
places of abede in some other state or states, I hereby declare that my above-described
:esidence 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 residing at ~ 9a S~ ~~ c~~o ,
'' ~ ~ • ~}~ ~ street a num er
~ u-v~" ;{~t ~~-~ , in .1-t .~~~.c ~:e,. County, Florida. I formerly resided at
~~ city J
'Z ~" e a-~c~u-{~~" Ct~••-c-- Q e~ ~~ ~,1 u,.c~....w~ ~ounty, ~°-`.~' ~, 2' , and the
city ~~ stat
~lace or places where I maintain another or othez glace or places of abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.)
gECAME A RESIDENT ON THE ~L DAY OF _~~ ~ jq b~ ~
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Sworn to and subscribed befors me this 2 y day of ~~~ , A. D. 1~'~'~ ~-'f'' ~~~~~'••ti'4; `~
. ~- ~:
ROGER POITRAS, C~ERtCCI~ftCUIT ~OI~TY: ;
_ ST~. LUC I E COUNTY FL#2 ~.~P ~ ;:~-
':otary Public State o Florida at Large. ~ ' "~ ~:~~
":1 Commission e ires Blr c;, ~.~ ~~~ .~'
XP ~~~ P U T_ G~f~ K
• ~~i~t'f'-,. '. `"~~:'~ ri
=0R DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLO~ "'•'~~;""'' ~ ~
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1.ereby declare t at my domicile is in the State of and that I intend
Fo permanently continue and mai~tain my domicile in suc state. At the time of making this
declaration 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,
and county of place of abode in Florida.? ' ~ ~~
'Person making declazation may also include such other and further facts with referen~e to
a~~y acts done or performed by such person which such person desires or intends not to be
~~nstrued as evi3encing any intention to establish his domicile within the State of Florida.)
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signature~
~•~orn to and scbscribed before me this ~ day of , A. D. 19
':otary Pub ic State of Florida at Large.
'fy Commission expires
:~~:-:~3~1 ~a~E1657