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DECIJIMTION OF DONIICILE
To the Clerk of the Circuit Court [County Canptroller~ ST. LUCIE County, Florlda.
This is my declaration of domicile in the State of ~~ti n , that I am filing
this day in accordance and in confonaity vith Section '~'~ . ,~Ior3a'a~3`tatutes.
FOR DOMICILIARIES OF THg S~J-T8 OF FLORID7~:
t hereby declare that I reside in and maintain a placa of abode at 3 u~n~Q~Q fi
~ ' , in ST. Ll1CIE County, Florida, whichrplace ofnabode I
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recoqnize and intend to maintain as my permanent hane and, if I maintain another place or
places of 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,
and i intend to continue it permanently as such. I am, at the time of makin th s d c ar ~
tion, a bona fide resident of the State of l~lorida residinq at ~.S~~B~ t .
~~ ~ ~ stree an n er
, in ~, t~~, County, Florida' I formerly resided at
_ ~~ ~ ~~'!
, County, , and the
c ty ~ s te -
piace or places where I maintain another or other place or placea of abode are as follo~rs:
(xere list atreet addresa, city, county and state of any other place or places of abode.)
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Sworn to and subscribed before iae this I~ day of S~ , 1~. D. 19 O~.
ROGER P011RAS, GLERK C IRCUI T COUtT
ST. LUCIE COUNTY, FLORIDA
Notary Pu~Yic State o~ FYorida at Large. ~
My Caomission expfres . BY ~~c...F~ DE P U T Y C l E R K
~ -
FOR DONICILIARIES OF STATES OTHER THAN TAE ST1~-TE OF FLORZWI:
er ec are t t my c e s the State of and that I intend
to permanently~continue and maintain my do~nicile in such state. At tne time of n-akinq 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 followa: (Here list street address, city,
and county of place of abode in Florida.)
{Person makinq declaration may also include auch other and further facts with reference to
any acts done or performed by such pezson which such person desires or intends not to be
construed as evidencinq any intention to establish his dcmicile Within the State of Florida.)
~ FiQ ~ 2 ~ ~ ~8
51~ _ i ST Ll CiF cru±! ~Y fi A.
ROGER POITRAS
CtEPK C!~~(:;1 r,rUqT~
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v~-
(siqnature)
swarn to and subscribed before me this
day of , A. D. 19 .
~
*r~tary Public State ot FYorida at Larqw.
!~y Comiaission expires .
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