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DECLAWITION OF DOMICILS
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7o the Clerk of the Circuit Court [County Comptroller~ ST. Ll1C1E County, Florida.
Tr,is is my declaration of domicile in the State of ~ 4~~~~ , that I aie filinq
this day in accordance and in conformity with Sectio ., or a-3`tatutes.
FOR DOMICIL2ARIES O!' THE STATE OF FLORIOAt
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1 hereby declare that I reside in and maintain a place of abode at ~_ ~~f {fdY1~ ~u~~,
~' ~-'~ S% ~ V G~ F , in ST. Ll1C 1 E County, Florida, whi hrplace ofnabode I
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recoqni:e and intend to maintain as my permanent home and, if I maintain another place•or
places o~ 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 principal haae,
an3 I intend to continue it permanently as such. I am, at the t f m ing this clara-
tion, a bona fide resident of the State of Florida residinq at I o N a ,
street an n r
~ ~ t' l ~. ~ u C~ E , in ,.~ T~ v C/ E County, Florida. I formerly resided at
(city)
~~~C' Q C~~ ~ , <% NG ~~ 9,G A County, yE ~ D/~~ and the
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place or places where I maintain another or other place or places of abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.)
L 2 o Cv ~~, ~L v n~ R F ,
d~' ; 5~~~ f~ c ~~ s E ~~e ~v d~~A ~d ~~ r ~yE~v ~~
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sworn to and subsc'ribed before me this
Notary PubYic State o~ Florida at Larqe.
My Co~omission expires .
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`~ day of F,f d ~'~- /~ ~ ~ , A. D. 19 ~ / .
ROGER P011RA S, GL ERK C I RCU I T COI~t T
ST LUGIE COUNTY, FLORIDA
BY EPUTY CLERK
; FOR DQMICILIARZES OF STATES OTHER THAN Q~ STATE OF FLORIDii~1:
I
I
' er ec are t my o c e s n e State of and that I intend
~ to permanently oontinue and mafntnin my domicile in such state. At the tin~ of making this
, declaration I am a bona fide resident of the State of . My place of
t abode within the State of Florfda, if any, is as follows: (Here i~st street address, city,
j and county of place of abode fn Florida.)
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(Person makinq 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 hie danicile ~+ithin the State of Florida.) ;
~ J`~16b0'7 .
198i f EB 1 I Al~, i ~~ 49
FIi~C ~hi ~: COPI'-[ i%
ST.LUC±[ CLUYiY.fIA.
~(?(,~F? p01+Fh:i
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sworn to and subsczibed before me this
*~otary p-bTic 5tate o F or a at Larqe.
!~y Commiaaion expires .
day of
8~K348 PAGE~6~
, 1~. D. 19 .
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