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522'704
DECLARATION OF DOMICILE
.
:~ the Clerk of the Circuit Court (County Comptroller~ ST. ~ UCIE
T
County, Florida.
:":is is my declaration of domicile in the State of ~~[> >[~ , that I am filing
~~~is day in accordance and in conformity with_Section ~~~~I~ari~a Statutes.
~R DOMICILIARIES OF THE STATE OF FLORIDA:
: hereby declare that I Xeside in and maintain a place of abode at ~~ 1y. ~; E=>-}- 7~'f'y1~'~"
~ street an nu er
~' ~~ a(` ~ ,, in ST. LUC I E County, Florida, which place of abode I
~ ~it~ ~
~~~cognize and intend to maintain as my permanent home and, if I maintain another place or
::,aces 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,
~~d I intend to continue it permanently as such. I am, at the time of making this declara-
- ion, a bona fide resident of the State of Florida residirq at ~~~~-{ ~,'E~-,t r"~~~r~~~
C-t~_~ -~street an num~be`rr-
' ~~~ ~a1-1 '~ll.~~'_t C . , in ~ .C ~.~~ . `~, County, Florida. I formerly resided at
- `~~-. ci~ ~
__ i~ 11`l~s~ ~ . ~~ -111~~% r1 County. ~~1-'~-1 ~~, C~'~ . and the
ci y '~- stateS
::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 or places of abode.)
BECAME A RESIDENT ON THE ~ OAY OF ~ 19- .
o :~ ^~~ ~
- ~ ~ ~C r-~-K 1'i ~ `~ ~-~
, ~ ~~ ~ ry~n ~e~, :~
~~ signature
;,t~~~t:~ai~~~,;:,
~ r~ ~ '~ .~.t-~r c~ `°'~:,
~worn to and subscribed before me this ~ day of , A. D. 1~~:~~•••.,,..~,y~ ,;
ROGER PO 1 TRA S, CL ERiC~C~1~f;U 1 T C.~0~ ~
~ L U C i E C O U N T~', F I s~ R~~ ~'; -
':~tary Public State of Florida at Large. ! Y`r :° --, t J'
~'~• Commission expires BY ~~ a~ c " '~_ ~ = [~ ' PUT Y_ • ~ RK
: i'~~' .:>r~
~OR DOM?CILIARIES OF STATES OTHER THAN THE STATE OF ~FLOR A: ~ •.''~,~"''~''k•;;,,=-'•;',:-
_ r.,'La~ .;'rr~d • •
.. , ::,_-
:.ereby declare t at my domicile is in the State of and tha't''Z~intend
~o permanently continue and maintain my Qomicile in suc state. At the time of making this
::eclaratioa I am a bona fide resid~nt of the State of M}~ place of
3bode 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 declaration may also include such other and further facts with reference to
3zy acts done or performed by such person which such pers~n desires or intends not to be
c::nstrued as evidencing any intention to establish his domicile within the State of Florida.)
19~1 !•~~:: - 2 1,E1 ~~ 2 I
:1_i[' Gh~ "~ Lr~:
~' LUl"IE 1':'IY' ~.f i~
~(iCG:-~ i OiiF~:S~
C~Etf C:^~':`. ('yn'~
, . ~
~
5~~ I 0~
Saorn to and subscribed before me this
~:otary Pub ic State of Flori a at Large.
'?~ Commission expires _
signature
day of
A. D. 19 .
~~'~K 351 P~~~ 2999