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516526
DECLARATIOP OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller) ST. LUCIE County, Florfda.
This is my declaration of domicile in the State of ~/Q- , that I am filing
this day in accordance and in conformity With Section ., or a tatutes.
FOR DOMICILII-RIES OF THE STATS OF FLORID]-: PQ~~~ky/~ ~/X
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1 heretiy ~~clare that I reside in and maintain a~lace of abode at i, .'
s ree an nu err
~ ~~, in ST. LUC I E County, Florida, which place of abode 2
c y
recoqnize and intend to maintain as n-y permanent home and, if t mafntain 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 constitutes my predominant and principa2 hane.
and Z intend to continue it permanently as such. I am, at the time of makinq th s clara-
tian, a bona fide resident of the State of F~lorida residinq at .
s reet en n r
_~~ . c~~ , in S~''~ • C, ~ , County, Florida. I formerly resided at
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_ .,~ J~~ ~ n CI.G m County, 1 h!) • , and the
~ state
place or pl c~e7s where I maintain another or other place or places of abode are as follows:
;Here list atreet address, city, county and state of any other place or places of abode.)
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Sworn to and subscribed before me this
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gnatu e
~ .S~~ryL rl~U/4Kes~
/ (~ day of
rlotary Pu ic State o F ori a at Larqe.
My Commisafon expires
~-,~~~ _ l~. D. 19~.
~~ . _ ,
ROGER P011'~tAS, CLERK G IRCU I T COI~tT
ST LUC 1 E COUNTY, FLOR 1 DA
BY EPUTY CIERK
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDa:
1 er y ec are t at my om c le s n the State of Gt~ and that I intend
to permanently contfnue and maintnin my domicile in suc sta e. At t e time of making this
declaration I am a bona fide resident of the State of . . My place of
abode within the State of Florida, if any,/'cOQ~" fol ors: ere i~eet address, ~ity.
and county of place of eI~ Flori a. ) ~ ~.,ek.c~o~ ~
Pers n m~~ d claration-maTalso ine~uch oth~3r and further facts with reference to
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any acts done or performed by such person which such person desires or intends not to be
construed as evidencing any intention to establish his domicile within the State of Plorida.)
516526
1951 FE~ 10 Pl~i 2~ 21
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ST. LL'~ti COi!!1' Y. F.~ .
ROGFR POIT~I•ti
CLERY.C•PC~Ai ff:.:~~
4.f „_ ::1- .: t . ~
siqnat e
sworn to and subscribed before me this day of , A. D. 19
r+otary P ic State o F ori a at Larqe.
~ty Co~nmf ssion expires
8IIOK348 PA~E~.015
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