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DECIJ-Rl1TION Of DOMICILB
5~6~80
-
To the Clerk of the Circuit Court [Ccunty Comptroller~ ST. LUCIE County, Florida.
This ia my d~claration of dwnicile ia the State of ~~o~-~ ~,9 , that 1 aa~ tiling
this day in accordance and in conformity With Section ., or a tatutes.
FOR DOMICILIARIES O~ THE S~ATB OF FLORIDAs
1 hereby declare that I reside ia and maintain a place of abode at ~~3 ~`i~rY s~A~.~' 8~`'~l!
~street and nwnderf
~. y~7 ~ tC~~ ~/~+ , in ST. LUG I E County, Flvrida, which place o! abode I
recoqnize and intend to maintain as a-y permanent home and, if I maintain another place~or '
places ot abode in some other state or states, I hereby declare that my above-described f
residence and aboda in the State of Florida constitutes my predomfnant and principal.hane, ,
and I intend to continue it permanently aa such. I am, at the time of makinq ~s declara- ?
tion, a borta fide resident of the State of Florida residinq at ?SO,~ ~'~TY ~s s,> ~ k 8/ ~/ ,
' „ (stzeet ar~ct number~ ;
- ~ ~%~T /-' ~~' ~ t , in ~~v ~,e County, Florida. I formerly resided at
tcity) ~'
~iQ M~ o /~~~~ .~ 71~7 ~ 7• ~ County, /~/~ w c~ c r se ~/ . and the
c ty ~State) '-
place or places Where I maintain another or other place or placea of abode are as follawss
(Here list atreet address, city, county and state of any other place or placea of abode.)
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Sworn to and subscribed before me this ~~ day of ~~. , 1~. Dr~,~pr' ~.,- ,~'~ i~. •_.
ROGER PO I TRA S, CL ' U f: ,~ ~tT
ST LUC I E COUNTY ~~ ~. ~. ^~ ~
1 ~- • ,y ~. ~ .
Notary Pub11c State oi Flori~a at Larqe. B~ ~~~" ~'C~.ERK
My Cammission expires . . , .
,.~ ~,.
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FOR DOI+IICILIJiIRIES OF STATES OTAER TH11N TAE STI~-TE OF ..~,~~~~. ,~ -..-
er ec are t t a~y c e s State of and that I intend
to pera~anently continue and maintain my do~nicile in such state. ~-t ttie 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 follrn+s: CHere list street address, city,
and county of place of abode in Florida.)
(Person making declaration may also include such other and further facta ~riEh reference to
any acts done or performed by such pereon which such person desires or intenda not to be
construed as evidencinq any intention to establish his daeicile Mithin the State of Ploride.)
516'~80
Sworn to and subsczibed before me this
raotary PufiTic State of~~or~3a at Large.
My Comaafs~ion .expires .
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R~GER POITR,:S ~
CIERK CI~iCU~i r{.~a+ (,
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rsiqnature~ - ~
day of , ~. D. 19 .
'-R 348 QA~~ 1457 ~
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