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' ~ DECLARATION OF IIO!!ICILE
To the Clerk of the Circuit Court (County Comptroller) ST. L UClE County, Florida.
This is my declaration-of domicile in ths State of . that I am filing
th~ day in accordance and in contormity wtth Section or a tatutes.
FOR DOMICILURIES Ol~ THE STATE OF FLORIDA:
I hereby declare that I reaide in and ma~intain a place of abode at ~ C ~T U,s
~ `~-T~free an nw~ er
~~~r ~ , in ST. Ll1C 1 E County, Florida, Which place of abode I
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recognize and intend to maintaia aa my permanent hane and, ff i maintain another place or ~
placea of abode in some other stata or atate~, 2 hereby declare that ~ay above-deacribed
reaidence and aboda in ths State of Florida~constitutes my-predominant and principal home,
and i intend to continue it permanently as such. i aa~, at the t e of maki this declarA-
tfon, a bona lide resident o~ the State p! Florida residinq at (~I t!
^ .-~r stree an n r
~AYT, , in . f 1 County, Florida. I fora~erly resided at
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~~mA'1M ~ IEc D Y Nt . ~~~CL A~V D~.Y`v County, ~
e ~ and the
p lace or p laces w
here I ma inta in another or other place or places of abode are as foilows:
(Here list street address, city, county and state of any other place or places of_abode.)
I BECAME A RESiOENT ON THE ~ OAY Of ~J ~ 19~_.
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Sworn to and subscrfbed before me this ~ day of ~ , 1~. D. 19~.
GER POI TRAS, CLERK C IRCUI T COI~tT '
~ ST UCIE COUNTY, FLORIOA
i Notary Pu ic State o or a at Larqe. -
My Commission expirea Btr E PUT tr C l E R ~y'~
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FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FIARIDA:
ere y ec are t at my c e s n the State of and that I fntend
to permanently continue and maintnin my domicfle in Buc state. At e time of makinq this
declaration I am a bona fide resident of the State o~ . My place of ~
abods within the State of Florida, if s~ny, is as follows: ere st street aaaress, city,
and county of plsce of abode in Ploriae.) ~
(Person makinq declaration may al~o include such other and furtt~r facts with reference to
any acts done or performed by such person which such person desires or intends not to be
construed as evidencinq any intention to establish his danicile within the State of Florida.)~
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sworn to ar?d subscrib~d betore ~ this day of ~ D. 19 . ~
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t~otary c tate o or a rge. -
My Commfssion expires , ~ '
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8~357' P~f 9z~ .