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DECLARATI02~1 OF DOMICILE
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xo the Clerk of the Circuit Court [County Comptroller) ST. I.UCIE County, Florida.
This is my declara~ion of domicila in the State of F~~/'~ ~~ , that I aun filing
this day in accordance and in confonaity With Sectfon Z3~7, F o~a~`tatutes. ,
FOR DOMICILII-RIES O!' THE STATE OF FLORIDA:
1 hereby declare_ that ~ reside in and maintain a placa of abode at ~63:Z S,F, t~o~'f'~'//o i~2a/. ~
~treet an~ nwwer~
~p~~L St. ~ y~; e , in ST. Ll1C I E County, Floridn, which place of a-Dode I-
tci~ty)
recognize and intend to maintain as my permanent 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 and abode in the State of Florida constitutea my predominant and principal hane,
and I intend'to continue it peneanently as such. I am, at the time of makinq this dec ara-
tion, a bona fide resident of the State of Florida residing at 1` ~2 S.E. f~or~: //o ~d.,
~ (street anc~ number~
/"Dr f S~ ,LUG e , in S~ • 1 N~+ ~ County, Florida. I formerly resiaea at
~c1ty) ~ 3-~ys y , ~
~1~Q ~ra ri<. ~ Ci~~ ~C~s['rnq~r~~ County~ ~~!'~1l~~~' , and the
c ~ty C stae~ ~
place or places where I maintain another or other plac~ or places of abode are as followa:
(Here list street address, city, county and state of any other place or places of abode.)
~oa n~ ,~: ~~t`-e~t s~. -~ Go 7
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~~etic Gr~dri~.~ ~~~r~l~•{ 22304 ,
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J ~L~ j'2-~Q
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sworn to and subscribed before me this ~ day a€ ~,f"~, ~. ,!~.
ROGER PO I TRA S, C4
. LUG I E COUNTY;
*~otary PubYiC State O~ Florida at Large.
!~y Commission expires . ~ ~'~-
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;,}f~ ~DUR T
., ~, - .
~~E'JEPt1TY CLERK
Ii FOR DOMICILIARIES OF STATES OTHER THAN THE ST~TE OF"li~OR~D~: ~
f er y ec are t t my o~aic e s the State of and that I intend
f to pezmanently continue and mafntain tny domicile in such state. At the time of makinq this
~ declaration I am a bona fide resident of tt~ State of . My place of
~ abnde within the State of Florida, if any, is as follors: (Here list street address, city,
and county of place of abode in Florida.)
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(Person makinq declaration may also include such other and further facts with reference to
any acts done or perfon~ed by such person Which such person desires or intends not to be
f
cnnstrued as evidencing any intentfon to establish his domicile ~ithin the State of Florida.) .~
516296
, 1981 FEli -9 IW il= SO
F:IE~ ehf ~: i;Uki:i ~
S1.LUCIC CCUH~Y.ftA.
ROGER PCI'tiAS. ~
CLERK C{RCUii COt;R~
K: i:; ~tt: •.: F~•: . ~. . _ .
(signature)
S»~orn to and subscribed before me thfs
day of , l~. D. 19 .
r~otary Public State o~ FYoride at Larqe.
!~y Commission expires .
$.~ 3~8 ~ fi~ - .
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