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516y~1
DECIJIRATION OF DOMICILE~
.
Z~o the Clerk of the Circuit Court [County Comptrollerl ST. L UCIE County, Florida.
This is my declaration of domicile in the State of ~~,~~ , that I am filing
this day in accordance and in conformity raith Section ., or a tatutes.
FOR DOMICILIARIES OF THE STATE OF FLORIDAs
I hereby declare that I reside in and mafntain a place of abode at ~Od .5, 7~'~y~ ,
. t's`tree~ ana nwnt>er)
<f , E~CE- , in ST. Ll1C I E County, Florida, which place of abode I
c ty
recoqnize and intend to maintain as my permanent haae 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 sn the State of Florida constitutes my predominant and principal haoe,
and I intend to continue it permanently as such. I am, at the time of makinq~is declara-
tion, a bana fide resident of the State of Florida residing at ,3~00 .S. 1~ ~ •
~ Cstreet and number~
'- /~ c,~eE , in S?~ ~•C G~C / E County, Florida. I forn~erly resided at
lcity) ~
~ ~ /~~,up,L , /~ E,v County, ~~l~o , and the `
rcity) (state) ~
place or places where I maintain another or other place or places of abode are as follows:
(xere 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 / 3
Notary Pu~Yic State of Floric~a at Large.
~y Commission expires .
J c* ,(/ - /~ra~'
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da of , . . 19 ~ •
ROGER P01 TRAS, CLERK C IRCU I T COURT
ST LIIC I E COUNTY, FtOR I OA ~
BY1~`~~--~c.~_ PUTY CLERK
, . `~~~
I F'OR DOIrIICILIARIES OF STATES OTHER THAN THE ST]-TE OF FLORID~:
! ere y ec are t at my omsc le is n the State of and that I intend
~ to permanently continue and maintnin my domicile in such state. At trie tfine of makfng this
3eclaration I am a bona fide resident of the State of . My place of
~ abo3e ~-ithin the State of Florida, if any, is as follor+s: (Here list 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 Which such person desires or intends not to be
construed as evidencinq any intention to establish his domicile within the-State of Florida.)
l981 F~~ 13 P~1 2~ ~~J
5169'71 si~i`uci"cr~ri-°~'i': a
. RfGE F+ PGI7RAS
CLE"r.i<. Ci~iCUrT C~U"',.
~ .'~, . . . .
Csiqnature)
sworn to and subscribed before me this
*~ctary Purilic State o~ Florida at Large.
My Commission expires ~ .
day of , A. D. 19 .
a~~K348 PAGE~.860 .
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