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DECLARATION OF DOMICILE
To the Clerk of the Circuit Court (Count}~ Ccmptroller)
ST. LUC I E
/
~
County, Florida.
•This is my declaration of domicile in the State of ~ ~' L,4 , that I am filing
t!~is day in accordance and in conformity with Section ~., F or~tatutes.
40R DOMICILIARIES OF THE STATE OF FLORIDA:
: hereby declare that I reside in and maintain a place of abode at y~ ~~ f~~~~ ;(~~ //~)'~{! ,
street an nuT~-
, in S T. L UCIE County, Florida, which place of abode I
city
recognize and intend to maintain as my pern~anent home and, if I maintain a~other place or
places of abode 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,
a~d I intend to continue it pe~anently as such. I am, at the time of making this declara-
*ion, a bona fide resident of the State of Florida resi@inq at ~L~ ~,L/,~ ,/« ~„~~,~~,,~ ,
Zstre~t an num~-
-~~: `~? ~ ~~~ ' - , in ~~. j ~,~_i ~~ County, Florida. ~ I formerly resided at
~~ city ~
"~. ~ - -- ,.~~-' . _i :j_ % ~ fL ~~~ ' County, ~;-; state , • and the
Y
place 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 abode.)
' BECAMIE A RESIDENT ON THE _~ OAY OF ~ f ~ 19 ~~l .
i. ...
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signatur , J~ . ~'`
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~~worn to and subscribed before me this ~v day of ~QiL_~~ , A. D. 19~/.,. ~
ROGER PO I TRA S, CL ERK C I RCU I T COURT
ST. LUC I E COUNTY, FLOR I DA
';~t3ry Public State of Florida at Large. /J ~~
My Commission expires BY /~;~,,,~. ~ ~/>~_~-c:,~ DE P U T Y C l E R K
1T~'~,•--
~OR DONIICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
c
:.ere y dec are t at my domicile is in the State of ~~~ ;~r,q and that I intend
~o permanently continue and maintain my domicile in sucfi state. At the time of making this
declaration I am a bona fide resident of the State of ,~'.,r~; F~ . My place of
abode within the State of Florida, if any, is as follows ~THere ist street address, city,
and county of place of abode in Florida.)
'~erscn making declaration may also include such other and further facts with reference to
a::y acts doae or performed by such person which such person desires or intends not to be
~~-~strued as evidencing any intention to es±ablish his domicile ~rithin the State of Florida.)
1981 ~f~~ 30 t 1~ 12- 32
F'_'.C lt~C =: C6F::.
5: l liCiF C( I,,y' .~,
liCGER f'!,t ~ ~,:~; ..
, .CIEr~.ii C;':"~ T ", ' ~
~ r~~
5~21'7U
:=~~orn to and subscribed before me this
signature
day of , A. D. 19
`;~•tary Pub ic State o Florida at Larqe.
~';• Commission expires
;
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~~'~351 ~~~2(~7