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DECLARATION OF DOMICZLE
To the Clerk of the Circuit Court [County Comptrol~er] ST. L UCIE County, Florida.
This ia my declaration of domicile in the State of 7~ ~^~ , that I am filinq
this day in accordance and in conformity with Section Z.-, ori~la 3`tatutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDAt
i hereby declare that I reside in and maintain a place of abode at . Sf". ,~,u~ ~ ,~
~ .
~~t s~~~ ~- ~ e
, in STi LUC i f
County, s ree anct n er
Florida, which pZace of abode I
tcity)
recogniae and intend to maintain as my permanent home ~nd, if I maintain another place or
places of abode in some other state or states, I hereby de clare that my above-described
residence and abode in the State of Florida constitutes my predominant and princfpal haae,
and I intend to continue it permanently as such. I am, at the tim of makinq this declara-
tion, a bona fide resident of the State of Florida residinq at 3 , S 'C.
~f • S , t-t C i~
, in ~'t ~~ UC i~
County, street an n er
Florida. I formerly resided at
' D c,~ S U~
~. c tx
~. .
, ~~ C r S ~~ ~
County, /~ ~
~J ~. , and the
place or places where I maintain another or other place or places of abode are as fo2lows:
~xere list street address, city, county and state of any other place or places of abode.)
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5worn to and subscribed before me this ~~ day of ~e.G~c~---, . A. D. 19 ~~.
. `
ROGER PO 1 TRAS, CLERK C IRCU i T COU2T
ST. Ll1C! E COUNTY, FLOR I OA
Notary Public State ot Floricla at Large.
My Commission expires . B Y~~ ~`- DE P U T Y C l E R K
c
fiOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIOA:
er y ec are t at my omic le s n the State of and that I intend
to pernianently continue and maintain my domicfle in such state. At the time of makinq this
declaration I am a bona fide resident of the State of My place of
abode within the State of Florida, if any, is as follovs: (Here Yist street address, city,
and county of place of abode in Florida.) ,
(?erson making declaration may also include such other and further facts with reference to
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 daaicile vithin the State of Florida.) .
51Ei545
1981 f EQ 10 F~~ 3{ 7
f~.~ c atir ~: cur:~: .
Si.LU~-f CGUYTY.fi:•
ROGER F011F~AS
CIERK CI~ ~L"• CO'.;'a~
sr _• ;.•. ~.t r . _ p ~l
~7
(signature)
sworn to ancl subscribed before me thfs
rlotary Public State of Fiorida at Larqe.
My Commission expires .
day of , A. D. 19 .
6~'Jl( ~~S PACE ~~4
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