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DECLARATION OF DOMICILE
~ro the Clerk of the Circuit Court (County Comptroll~r) ST. LUGIE County, Florida.
This is n-y declaration of domicile in the State ot ~ ~ , that I am filinq
ti~is day in accordance and in conformity with Section ., or a tatutes.
FOR DOMICILIARIES OF THE STATB OF FLORIDAz
~
z hereby declare that I reside in an8 maintain a place of abode at ~'~ S~~L~ ~.
`~(~-~- ~er c~,t_.. , in ST. L 1 E County, Florida, whichrplace ofnabode I
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recoqnize and intend to maintain as nry pesmanent home and, if I~aaintain another place or
places of abode in srnae 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 t~ae of makin this declara-
tion, a bona fide resident of the State of Florida residinq at /G .
_~ \ ) street an num er
-1{~ ~~ , in s'? ~ l 1.1~ ~~ County. Florida. I formerly resided at
c ty `~ n , ~
1,~~ • -e- . 1~~~_G^ 1~ S County. l~~') S~ , and the
~ ty s`ta`t~. -
p1aCe 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.)
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Sworn to and subscribed before me this ~_ day of
l
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si at e ,~
~~~,,,~ A. D. 19~~.
ROGER P017RAS, CLERK G IRCU I T COt~tT
ST. LIIG i E COUNTY, FLOR I OA
BY ILa.Q~DEPUTY CIERK i
Notary Pu~1ic State of Florida at Large.
My Commissian expires •
I FOR DOMICILIARIES OF STATES OTHER THP-N THE STATE OF FLORIDiA:
f ere y ec are t t my om c e s n the State of and that i intend
to permanently oontinue and maintain my domicile ia such state. At trie time of makinq this
declaration I am a bona fide resident of the State of . My place of
abode rrithin the S.tate of Florida, if any, is as follows: (Here list street address, city,
and county of place of abode in Florida.)
(person making declaration mt~y 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 ,
canstrued as evidencinq any intention to establish his damicile Within the State of Plorida.) ,
516462
~81 FE8 10 ~.+~ 1~ 28
t t.EO tKt ~: c.~ri.~t J
ST LUCIE CC~'~. Y.F ~ a.
ROGER Fd~SR~S
CtERK CIRGJil CCUPI
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pt _f...:. \ •
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~ ~~ nature
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Sworn to and subscribed before me this ~(~ day of ~ a~, ~• D. 19 ~~.
Notazy Purilic State o~ PYorida at Larqe.
~y Commission expfres .
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e~~x348 Pa~~ 933
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