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DECLARIITION OF DOMICILE
To the Clerk of the Circuit Court (County Comptrflller~ ST. L UCIE County, Florida.
This is my declaration oi domicile in th~ S~ate o~ ~'~bv~~ , that t am filing
this day in accordance and in confonaity with Section ., ~a 3~tatutea.
FOR DQhlICILIARIES OF THE STl~TE OF FLORIDl1:
1 hereby declare that I reside in and mait~tain a place of abode at ~3P1 S a., Sv ~~•,R T-.r. ~
f~'.r~ Sf ~.c c i~c , in ST ~ Ll1C I E County, Florida, whi hrplace otnabode I
lci~ty)
recoqnize and intend to maintain as my permanent home and, if i maintain another plare or
places ot abode fn some other state cr states, I hereby declare that my above-described
residence and abode in the State of Florida constitutes my predominant and principal hame,
and I intend to continue it permanently as such. I am, at the titne of makinq this declara-
tion, a boi-a fide resident of the State of Florida resfdinq at~,~~/ Sa..~ Sp/..,G T~-^-r• ,
~~ S f uc i;C 33 y S.~ , in ' ~reet an~ nwnber ~'
~ f ~ ~ f•~ u~~.~ Cownty, Florida. I for~nerly resided at
(citY) ~-r-s.ti, ~
l~'l. /j!~ f~ov f~ /~ ~ec,~• ~a~r ~, y County, bvc<. , and the
r ty ~state) ~
place or places Where I maintain another or other place or placea of abode are as follows:
fHeXe list street address, city, county and state of any othez place or places of abode.)
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Sworn to and subscribed before me this /0 ~ day of
2rotary Public State o~ Florida at Larqe.
My Commission expires .
e~'.e 8 ~ 1-. D. 19 g/ . ~ -
ROGER PO I TRAS, CLERK C IRCU t T COl~2T
ST. LIIG I E COUNTY, FLOR 1 QA
B r ~-rr~e~-, ~Y~ ~ D E P U T lf C l E R K
y lY . t
FOR DOMICILI~RIES OF STATES OTHER THAN TRE ST1~-TE OF FLORIDiA: ~
er y ec are t a my omic e s n the State of and that I intend
to permanently continue and maintain my domicile in such sLate. At trie time of makinq this
declaration I am a bona fide resident of the State of My place of
abode ~rithin the State of Florida, ff any, is as follows: (Here i~st street address, city,
and county of place of aboc3e in Florida.}
(person makinq declaration may also include such other and further facta with reference to
any acts done or perfonaed by such person Mrhich such person desires or intends not to be
construed as evidencinq any intention to establish hfs domicile wfthin the State of Plorida.) ~
. 526465
1981 fE~ IO f,~ l~ 31
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C[ERK Cl~r.v~~ ~~~~ f ~
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sworn to and subscribed before me thfs
r7otary Public State o~ Florida at Larqe.
!~y Commission expires .
(signature)
day of , A. D. 19
~~3~8 Pa~~ ~s
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