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5162'~"7
DECLAWITION OF DOMICILB ~
To the Clerk of the Circuit Court [County Comptroller~ ST. LUCIE County. Florida.
This is my declaration of domfcile in the State of /~~. , that I am liling
this day in accordance and in conformity with Section ., or a tatutea.
FOR DOMICILIARIES OF THS S~ATE OF FLORI0~1s
I hereby declare that I reside in and maintain a place of abode at ~~ ~~
~j i ~ -(stzee n er
~~'~/~t~~Q~ , in ST, LUC 1 E County, Florida, vhich pla ot abode I
rcztyl
:ecoqnize and intend to maintain as my penaanent home and, if I maintain another place or
places of abode in some other state or states, I hereby declare that my above-described
residence aad abode in the State of Florida constitutes my predominant and principal haae,
and I intend to continue it permanently as such. I am, at the time of ing s declara-
tion, a bona fide resident of the State of Florida resfdinq at / .S .
~.~ ~- _ s t an n' r~
~,2~,P, , in t2ct,rsZ- County, Flor~da. I formerly resided at
~ ~Y) ~
~~''0`; . ' co~ty, ~ , and the
c ty Cstate) -
place or places where I maintaia another or other place or places of abode are as folla+s:
(Here list street address, city, county and state of any other place or places of abode.)
:~~ co'~NT y~o
'J ~ :G
c~c ` ~~ . ; ~
~ ~. t./'`~`~ : ~n
f ~~...u~~''. .~
`R:•~r` ~.JKt~.'~~~_~'
/
~ C~ . i'~/
J ~ ature
`_' L y,~~A NRT~h
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sworn to and subscribed befoze me this ~~ day of ~*~"~~ , 1-. D. 19 ~l .
ROGER P01 TRAS, CLERK G IRCUI T COl~2T
ST. Ll1C 1 E COUNTY, FLOR I 0/-
Notary Public State o~ FYori~a at Larqe. ~~
My Commissfon expires . BY - DEPUTY CLERK
FOR DOMICILIARIES OF STATES OTHER THAN TRE STATE OF FLORIDa1: ~
. .
er y ec are t t my rnn c e s n the .:State of ~ .~:.r~-'~ and that I intend
ta permanently continue and maintain my damicile in su ~~ er the time of niaking this
declaration I am a bona fide resident of the State of . My place of
abode withia the State of Florida, if any, is as folloWS: ere st street address, city,
and county of plac~e of abode in Florida.)
(Person making declaratfon may also include such other and further facts with reference to
any acts done or perfonaed by such person which such person desires or intends not to be
constzued as evidencing any intention to establish his domicile within the State of Florida.)
S162'7'7
q81 FEB -9 ~~? ,~ 47
F ll! C ~h[ '•'. COdCI ~
S AOGER P(IItRAS~
CLERk C!F^t;±? Cf;,'~ ~
-r- - • • ~
sworn to and subscribed before me this
t~otary Fubiic State ot FYorida at Larqe.
My Con~aission expires .
~ ~
vif siqnature
day of , A. D. 19
6oou~~S PaGE UW
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