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DSCLl1R~1TION OF DOMICILE
~~
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To the Clerk of the Circuit Court [County Cvmptroller) ST. L UCIE County, Florids.
Thia i• my declaration of domicile in the 8tate o! ~~p . , that I as filinq
this day in accordance and in conformity with Section ~. ,. or a tatutes.
FOR DOMICILIARIES Olr THS S~ATB OF FLORIDl-t
~ hereby declare that I reside in and maintain a place of abode at ~ ~.i.v G oC ~. ~"~
s ree and nunu~er f
_~ ~, S' 7~ v~,~P . , in ST ~ L i E County, Florida, which place ot abode I
c y
recoqnise and intend to maintain as my permanent hane aad, if I maintain another place~or
places of abode in a~ne other state or statea, I hereby declare that my above=>deacribed
residence and abode in the State of Florida constitutea my predominant and principal hane,
and I intend to continue it permanently as such. I am, at the tiiae of making this declara-
tion, a bona fide resident of the State of Florida residfng at ~ v/~~U ~C ,~.~: a r
~ s reet an num er
~, . ~ u c. l~ , in ~t S~. ~. ~ c ~~ County, Florida. I fonoerly resided at
c ty ~
.' ~~ ~ t u~ L 7~ i r,~t w~~ t C~unty ~ w~ ~~i s/ , and the
c ty sta e -
place or places where I maintain another or other place. or places of abode are as follo++ss
(xere list atreet address, city, county and state of any other place or places of abode.)
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(~w~~'wES,.~ `OQ~~ ~A j J~C~ eC~f
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sworn to and subscribed before me this ~~ day of ~•~~~+~y , l~. D. 19 ~~ . •~
ROGER PO I TRA S, CL ERK C i RCU I T COI~t T
ST. Ll1G 1 E COUNTY, FLOR I OA
~, Notary PubYic State of Florida at Larqe. ~]h~ ~~~~~~~
~ My Caem~ission expires . 8Y_ ~~~~.e~ o/'^"-~-~-~t DE P U T Y C L E R K
i ~
'~ .
j FOR DO[~lICILIARIES OF STATBS OTHER THAN TRE STl~ITE OF FIARID~1,:
I
' er ec are t t my oan~c e s n the State of and that I intend
to permanently oontinue and maintain my damicile in such state. 1-t ttie 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, is as follrn+s: {~ere ~st street address, city,
~ and county of place of abode fn Florida.)
(person making declaration may also include such other and further facts ~+ith reference to
any acte done or performed by such person which such person desizes or intendg not to be
construed as evidencing any fntention to establish his danicile within the State of Florida.)
516'70'7
~ FEa ~ z a~ ~ ~ 4
FIIEC ~Hi ~f Lu~ti: C
SI.LUClE GGUYi'~ f t a.
ROGER POITRAS
CIERK C1RC1:~' ~~"y:~~'
or2 r:.. -_.c r,~ . ~ ~, p/r. -
sworn to and subscribed before me this
r:otary p-'bTic State of PTori~a at Y.arqe.
My Com~aiaaion expfres .
:
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t``~~~~',,~ '^~~~ ~ _ .-;,~- ;
day of
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~~0 348 PAGE13~37 " ~
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lsiqnature)
, ]-. D. 19 .