HomeMy WebLinkAbout1016!~
~1652~
DECLARIITION OF DOMICILE
mo the Clerk of the Circuit Court (County Comptroller~ ST.. l UCIE County, Florida.
This is my declaratioa of domicile in the State of ~O~ i,~~q , that I am filing
this day in accordance and in confonaity With Secti n l~~':IT, F or a tatutes.
FOR DOMICILII~-RIES OF THE STATE OF FLORIDA;
i hereby declare that I reside in and maintain a place of abode at ~~/~~p~/,y~L~ ~~~p ~ B/,
)
~lt~i „~~_~/~i~ , in ST. LUC I f County, Florida, whichrplace~of abode I
tc y
recognfze and intend to mainLain as my permanent home and, if I maintain another place or
places of abode in some othez state or states, I hereby declare that my above-described
residence and abode in the StaLe of Fiorida constitutes my predominant and principal hame.
and I intend to continue it pern~anently as such. I am, at the~e of maki this declara-
tion, a bona fide reside~t o# the State of FZarfda residinq at , ~-/ ~
~ s reet an num~~et)
,~ T~ Lt ',~ , in~]'~~~~ County, Florida. I formerly resided at
Y ~
~ ~ ~ c t ' ~~s ~~~~ County, , and the
(state)
place or places where I maintain another or other place or places of abode are as folloWS:
(t3ere list street address, city, county and state of any pther place or places of abode.)
~\ ~ COUN~Y
V\rf+• ~~G
~: :~
c.~ ; c --~
: e Cq,
~(/C~~ COUNi`(~ F~"~P`o+'
sworn to and subscribed before me this 1(~
Notary Public State o~ FYorida at Large.
My Commission expires ,
~~
~
~ Csiqnature) ,
~I a~~~rT ~ Q~`G~.$lJ~Q.
/
day of , ~1. D. 19~.
ROGER PO I a S, CL ERK G 1 RGU I T COI~t T
ST. LUC ! E COUNTY, FLOR t OA
BY 1~~ DEPUTY CLERK
FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIOA:
er y ec are t at my omic e s n the State of and thnt I intend
to permanently oontinue ana maintain my domicile in such state. At trie time of making this
declaration I am a bona fiae resident of the State of My place of
abode ~rithin the State of Florida, if any, is as follows: iAere Y~st street address, city,
and county of place of aboc3e fn Florida.)
(Person makinq declaration may also include such other and further facts with reference to
any acts done or performed by such person whfch such person desires or intends not to be .i
cozstrued as evidencfnq any intentfon to establish his domicile within the State of Florida.) ,
51652`'!
1381 FE~ I 0 P!~ 2~ 2!
F~~fc ~Nr ~:c~~.:~,~
S RCGE R FCI TRt.:; ~
CLERKCtRCU1~ CC' ~
p-~-R~ ~~~ ~i: ~' ~
(signature)
sworn to and subscribed before me this
day of , A. D. 19
Notary Pubiic State ot Florida at Large.
M}~ Commission expires ,
a~ ~~8 ~~E 1o~s
___ _ r _ _ __ :~ ~
~~.~s~. ,.~t.::_ _-~ , ~_-~._~