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DECI.ARATIO?J OF DOMICIL~
~-
.c the Clerk of the Circuit Court fCounty Comptroller) ST. L UCIE County, Florida.
~
^~is is my declaration of domicile in the State of -~'. ! -i , that I am filing
~':is day in accordance an3 in conformity with.Section ~~~3, F o~a Statutes.
~~~F DO!~lICILIARIES OF THE STATE OF FLORIDA:
: hereb declare that I reside in and maintain a lace of abode at `' I' ~ '
Y P „L~ ~ ~ •
street an nu er
~ ~ , in S T. ~UCIE County, Florida, which place of abode I
city
:-ecognize and intend to maintair. 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
=esidence and abode in the State of Florida constitutes my predominant and principal hame,
a-~d I intend to continue it pern,anently as such. I a.-n, at the time of makina this declara-
~ion, a bona fide resident of the State of Florida residing at i~~~ A~ '-~-: . -' ,
- - street an num r
'~ , in ' ~ County, Florida. I formerly resided at
city ~L'
, County, , and the
city state
.-:ace 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 cr places of abode.)
~ECAME A RESIDENT ON THE DAY OF • ~ 19 •t- `.
. ~
'~~L:E 9~''••.
~~'C~UNly
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. •~ L; ~ :-~ s ~ ~ - ~ ~ - ~ . •
, •~., _a--~~ ~ signature
: , ~'F r
'_w. -~
~worn to and subscribed before me this _SC day of ~1~-?ti<~ , A. D. 19 ~~
ROGER POI TRt~S, CLERK C IRCUI T COURT
ST. LtK 1 E COUNTY, FLOR i DA '
:~tary Public State of Florida at Large. --. 7y~
~f.: Commission expires B~ `~ ~^-!~-, •'/~ _.•~' ~~L. DE PUT Y C L ERK
~",F DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
~ ,~,~
_~:ereby declare that my domicile is in the State of and that I intend
-c 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 olace of
a~ode within the State of Florida, if any, is as follows: Here ist street address, city,
:^~ county of place of abode in Florida.)
~ersoR makincr declaration may also inciude such other and further facts with reference to
_.:: acts done or performed by such person which such person desires or intends not to be
_=::strued as evidencing any intention to establish his domicile within the State of F2orida.)
19~! F!.~Z 30 Ph 3- t G
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~~w~rn to and subscribed before me this
':•-~tary Pub ic State of Florida at Lazge.
'~.• Commission expires
s_gnature
day of , A. D. 19
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