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DECLARATION OF OOMICILE
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To the Clerk of the Circuit Court [County Comptroller~ ST. L UCIE County, Florida.
This is my declaration of domicile in the State of ~~~ ~• ~ ~ " , that I am filing
tt-is day in accordance and in conformity with Section ~~'~'.T~J'~Io ~cla 3`tatutes.
FOR OQMICILIARIES OF THE STATS OF FLORID~t
I hereby declare that I reside in and maintain a place of abode at ~-~S~ ~-~.1~ 5-~- .,
street and ntunberf-"
~-. I-~c.: e~ , in ST. LUC I E County, Florida, which place of abode I
city)
recoqnize and intend to maintain as myr permanent home and, if I maintain another place or
placea of abode in some other state or states, I hereby declare that my above-described
residence and abode in~the State of Florida constitutes my predominant and principal haae,
and I intend to continue ft permanently as such. I am, at the time of making this declara-
tion, a bana fide resident of the State of Florida resfding at ~..~5-t _ Z+~.l~~~ . .
~street an ; number~
(~,~~-~- S+. ~-~~; e... , in ~~-~- L._._.c.: e`, County, Florida. I formerly resided at
(city) ~ ~
¢1 , ~-{~ ~ County, -~- , and the
~ r~ty~ state ~
place or places where I mafntain another or other place or places of abode are as followa:
(Here list street address, city, county and state of any other place or places of abode.)
.~
~ ~OUlyl
~ •• ~:E a,; ~•,, f'
J~ r• ~~C~O
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tsignature) ~RN ~ e'/
Shorn to and subscribed before me this ~~ day of ~~~ ~]~. D. 19~ .
• ROGER PQI TRAS, CLERK C IRCUI T COU2T ~
ST. Lt1C I E COUNTY, FLOR I OA
Notary Pub~ic State o~ Florida at Large. ~
My Cammission expires . 8Y ~h~~ DE PUT Y~ L E R K ;
FOR DOMICILII~IRIES OF STATES OTHER THAN THE STATE OF FLORIOA: ~ ~
er y ec are t at my c e s n the State of and that I intend
to permanently oontinue and maintnin my domicile in such state. ~t the time of making this
declaration I am a bona ffde resident of the State of .!~!y place of
abode wfthin the State of Florida, if any, is as follows: tAere Isst street address, city,
and county of plsce of abode in Florida.) -
(Person making declaration may also include such other and further facts ~rith reference to .
any acts done or perforn~ed by such person which such person desires or intends not to be
construed as evidencinq any intention to establish his damicile wfthin the State of Plorida.) ~
5163U8 ~
1981 FFU -9 F~~ i?~ 3~
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tsiqnature)
Sworn to and subscribed befoze me this
day of , A. D. 19 .
Notary Public State o~ PYorida at Large.
My Connnfssion expires .
BOOh 348 PA~E 646 . ~
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