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5165'70
DECLAR)1TION OF DOMICILS
.
To the Clerk of the Circuit Court [County Comptroller~ ST. Ll1C1E County, Florida.
Thia is my declaration of daaicile in the State of ~GO~ip , that I am filinq
this day in accordance and in conformity With Sectfon ., or a tatutes.
FOR DONICIL2ARIES Olr THE S'PATB OF FLORIDAt
1 hereby declare that I reside in and maintain a place of abode at 7~~ ~'•~ ~l/~ ~~
tstreet an~ n r
~C~LT ~T• Lt/GiF' , ia ST. LUC I E County, Florida, which place of abode I
~cxtty)
recognize and intend to maintain.as niy permanent haae and, if I maintain another place or
placea of abode in soaee other state or 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 aa~, at the time of makinq this declara-
tion, a bona fide, resident of the State of Florida residin at 788 S• ,E. /~v .~c,,~a,ar!' ~~:
g (street an~number) ~
~.eT ~7' LvG~' , in S'T. Lvy.E County, Florfda. I fonaeirly resided at
tcity) ~
/~~9M• . QRj3F County, ~~-o.f%c~q , and the
lcity) (state) ~
place or places where I mafntain another or other place or places of abode are as followss
txere 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 ~,~i~a-z y , 1-. D. 19 8~ .
'' ,~ ROGER P01 TRAS, CLERK C IRCUI T COU2T
.= ~~~ICfi~G- ~-~'`=~-~~~~~ ~ ST. LUC I E COUNTY, FLOR 1 DA
Notar`y ~ic State ofrF~lo~~l ~ at..,La~ e. ~
~ ~~' "' %~ nt ~•e~E ~ BY DEPUTY CLERK
My Cammfssion expires -.
. . , . . . .. ,...,~< i~ ~ • .3 \.
FOR DO!lICILI]-RIES OF S~X'Y''E'3 -~l'~lER"'1'lfAN'a!A'E"STA't~l~F FLORID~A:
er ec are t a my om c e s n the State of and that I intend
to permanently oontinue and mafntafn my domlcile in such state. At trie time of makinq this
declaration Z a~a a bona ffde resident-of the State of . My place of
abode vithin the State of Florida, if any, is as follows: tHere fist street address, city,
and county of place of abode in Florida.) .
(Person makinq declaration may also include such other and further facts with reference to
any acts done or performed by such person vhich such person desires or intends not to be ;
construed as evidencing any intention to establfsh his domicile vithin the State of Florida.) ~
~
I~ FE8 I I At~ ~ 59
FiLrc Rr+r FecaFnt n
Si. WCiC GoUNTY.Ft A.
ROG~R POITRAS
~LERR ~I~CU~T r,rU~T ~
r: , , ,:~.~ ~• C~
5165'7p
;~
(siqnature)
sworn to and subscribed before me this
day of , l~. D. 19 .
Notary -bTic State of'Flor~~a at Large.
My Com~nission expires .
8~348 Pa~F1102
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