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To the Clerk of the Circuit Court (County Comptroller) ST. L UCIE County, Florida.
:his is my declaration of domicile in the State of , that I am filing
c'~is day in accordance and in cor?formity with Section F ori a Statutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDA;
T hereby declare that I reside in and maintain a place of abode at 3 Lt/~v~/~~~• .
1 street a~T n er
~ E ,~in S T. l UCIE County, Florida, which place of abode I
city
recognize and intend to maintain as m}~ permanent h~me and, if I maintain another place or
places of abode in some other state oz states, I hezeby declare that my above-described
residence and abode in the State of Florida constitutes my predominant and principal hane,
and ~ intend to continue it permanently as such. I am, at the time of makinq this declara-
tion, a bona fide resident of the State of Florida residing at S//Q ~,,1~~~,r/F .~~ff~ •
~'stree~d num~erT-
~.a,~,~ ~j~=,~L•~ , in ~ LuC~~ County, Florida. I forn?erly resided at
cityT- ~ ` ~
~~i 57`L'i•;
T,- . 16~~ S'~ CountY. i/t/ , and the ~
city tate
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.)
l BECAME A RESIDENT ON THE ~T ~AY OF mA ~ 19~. i
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Sworn to and subscribed before me this day of rry , A. D. 19~~.
ROGE P01 TR~S, CLERK C IRCUI T COURT
ST Ll1C I E COUNTY, FLOR I OA
tiotazy Pub2ic State of F orida at Large. \
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M}• Commission expires BY ti DE PUT Y C L E R K
I FOF.I70PIICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
I
r.ereby declare that my domicile is in the State of and that I intend
~o permanently continue and maintain 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 F~orida, if any, is as follows: Here ist street address, city,
~ and county of place of abode in Florida.)
!Persc:n making declaration may also include such other and further facts with reference to
any acts done or performed by such person which such person desires or intends not to be
ccnstrued as evidencing any intention to establish his damicile within the State of Florida.)
S~6'750
~ - ~ 31
1981 4 ~'l,~ :I•
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~_•.;~rn to and subscribed before me this day of , A. D. 19 '
i
~~o~ary Pu ic State o Flori a at Large.
u,: Commission expires
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