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51~055
~ DECLARATION OF DOMICILE ~
:a the Clerk of the Circuit Court [County Comptroller~ ST. LUCIE County, Florida.
This is my declaration of domicila in the State of }= LoR+dA. , that I am filing
this day in accordance and in confozmity wfth Section ~:I~~I'oriTa ~tatutes.
FOR DOMICILIARIES OF THE STP-TS OF FLORIDl~:
Sc~ ~anu~ow
~31e ~ a~,
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Sworn to and subscribed before n-e this 1~i day
~Notary•Pu~YiC State o~ Florida at Large.
My Cammission expires .
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s ~gnatu e ```~;. `~ .: ;, i',~~ r
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of ~'e~_ , ~.~.~~: : ~,A :~~... .
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ROGER P01 TRA S, G~ ~ ,.~~ ~.~Ol~t T
ST. LUG i E COUNTY,? #` ~-_ "
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B ~r,. ~'."~DErMUTY CLERK
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FOR DOMICILIARIES OP STATES OTHER THAN TRE STATE OF FLOItZ~C ` ~
er y ec are t at my c e s the State of and that I intend
to permanentZy continue an8 maintafn my domicile in such state. At trie time~of making this
declaration I am a bona fide resident of the State of .!~!y place of
abode within the State of Florida, if any, is as follows: (Here list street address, city,
and county of place df abode in Florida.) ,~,
(Person makfng declaration may also include such 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 evidencing any intention to establish his daaicile ~rithin the State of Florida.)
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~61 f ES ~ 6 AK s~ ~: ~
fILEO ~K[ ~=~Gr.•i+i
Sf.LUCiC COUN ~ r•F ! %'
RCGER PGIiR."•5
CIERKC1zCl't: ~=;~~
F:--~~~~ - . ~ ' t!"~
rsiqnature)
sworn to and subscribed before me this
r~otary pulblic State o~ Florida at Large.
My Commission expires .
~
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i hereby declare that I reside in and maintain a place of abode at ~ S ~cX a 3J~ .
s reet anct nu~=T -
~' ,~r eaC e- , in ST, Ll1G 1 E County, Florida, which place of abode I
Ccity)
recoqnize and intend to maintain as my permanent home 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 an8 principal hane,
and I intend to cont~inue it permanently as such. I am, at the ti~g of mak~ nq this ~eclara-
tion, a bona fide resident of the State of Florida residinq at Kt~ _~o~ ~ 31 •
• ( etreet ancl number ~
F t ~~e~2~~ , in _,~T L u-c ~ e- County, Florida. I formerly resided at
Cci ) ~ / ~t
~~2 ~.~.~G. ~,26 e , ~ ac/~So,~/ - County, ~~ G!~ , and the
c ty state)
. . .
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place or places where I maintain another or other place or p laces o f a b o de are as fo l l o w sz
(xere list street address, city, county and state of any other place or places of abode.)
day of , A. D. 19 .
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