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T~, the Clezk c_` Lhe Circuit Court ~Cosnt~~ Cc-.~uo? ier? S' • ~~~- ~= Cesnt~•, F:-. _.....
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_r.is da}• in accorcance an~ in confern:itv ai_-: :ec~=or. <i~~`, Ficri:.a Sta~~~es.
~~,R D~-~SICILZAR=ES OF THE STA^_'E OF FLORi~A:
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::~erebv ne~iare tha_ I reside in and mair.tain a p2ace of abode at ~], ~~, ,-~__~ J-~ . .
. . ts~r~e~ er.~ ..::-•~ez
+,e ~~ ~,C,~~G , ir._ S~_ 1~!' ~' Co::r.t~•, Fi~rida. w:~ic}: ?iace c`'a~o~~ :
cit~- ~
_ ~o: nize an~ ~nten~ ~a rair.tain as r.t~• .---.. _..~^ =::_^° _~~, i_` I r..=_irta~n ~- c~:.=_ -: a = c.
:; ices of abone _n sone other state or s~acp•~:, ?:.c= e~•: aeclazP ~:':ot my eb;;~.•=-~ _._____-
_=sidence and abode in the State of Florica c~.^.s~itutes ry predo:*.~nant ar.~ ^r:::_~- a: .-~ .
a::d I intend to continue it oerinanently as s::c :. I am, aL the tir.;e or mai:ir __.._~ ~_____---
~,on, a bona fiae resinent of the State of Florida residing at
tstreet a.^c ..- '.- _: s
, in County, Florida. I foz~r:er2~r res.~e3 a~
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~`7c~ity, tstate ~
::ace or places wnere Z maintain another'or other place or places of abo~e nre as 'c'_?c•.:s;
~~!ere list stre ~ acdress, cit~•, county and state of any other oZace oz rla~es of a:~:'.~.)
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. ~...~aN+~rr~,, signat e
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~ worn t~ ~Ac.rt#~ before me this
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A. D. 19 ~l .
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~~ ROGER PO I TR~ S CL ER~K C I RCU i T COth2T
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~ ST. LUC l E COUNTY, FLOR I OA
,. _ ~ary` • ~
... ' •a ~~~` - ~ 8
, A~~S~~
BY
DEPUTY CLERK
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~'~R DOMICZLtARI~S'~'OF S ATES OTHER THAN TAE STATE OF FLORIDA:
r='zereby declare t at my domicile is in the State of and that I intend
-: permanent2y continue and ~r.aintain my domicile in suc state. At the tir.*.e o: making ~his
-~Iaration T am a bona fide resident of the State of M:~ ciace of
. ~de within the State of Fiorida, if ant•, is as follows: Here ist street a~cress, cit}•,
~-.d county of p~ace of abode in Florida.)
' erson nakina dec2aration r.~ay also inclu~e s~;ch other and further facts with rererence to
dCtS done dZ ~eZ~G~+:~'_C. L~ SL3.^..ti: _--°-'CG.^. M:==ti: S,ICh person ~°Sl~ES OZ 1L`_E:1C5 .T:^~ =0 ~`
_..::strued as evidencina an}• ir.ter.tion to es:ablish his oomicile within t`;^_ Sta.e c` T_~--~a•;
. ~ 5;~510
1981 AP' -1 A~ a 59
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RCuER POlii%A ~
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~»~rn to a.-~~ s;:~s~rihed ~~efore me this
`.~~ar~• Pub2ic State o: Fi~rida at iarGe.
~'~: Comr.~ission exnires
signature
day of , A. D. 19
6~'~x 351 P~~E 2670