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51~156
DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller~ ST. L UCIE County, Florida.
This is my declaration of domicile in the State of ~~ O j~A ~ , that I am filinq
this day in accordance and in conformity with Section ~~~.7~ F or a tatutes.
FOR DOMICILIARIES O~ THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at ~I/J~ ~i1~GE ~`~. ,
~ s ree an n r
F~ ~iP~f P , in ST. L UCIE County. Florida, which place of abode I
c ty
recoqnize and intena to maintain as my pera-anent 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 and principal hame,
and I intend to continue it permanently as.such. I ata, at the time of akinq thf declara-
tion, a bona fide resident of the State of Florida residing at =S%._ ~'/~/~~ G. .
stree an nui er
F~ P:e~ce , in f~ ~ vc~e County, Florida. I fonaerly resided at
c ty ~
, County, , and the
c ty state ~
place or places where I maintain another oz other place or places of abode are as follows:
(Here list atreet address, city, county and state of any other place or places of abode.)
~ ~ ~~~Ci~i~"
/
signature
. ~qvic( v~i ~
Swozn to and subscribed before me this /'7 day of ~'.e.~~a.w~ , l~-. D. 19 ~~ .
- . . ROGER P011RA S, CL ER K C I RCU I T COU2 T
ST. LUCIE COUNTY, FLORIDA ~
rlotary Pu ic State o F ori a at Larqe. 1 ~,
My Commission expires . B~~-r~r DE P U T Y C L E R K
F`?R DOIrIICZLIARIES OF STATES OTAER THAN THE STATE OF FLORIDA:
er y ec are t at my o c le is n the State of and that I iritend
to permanently oontinue and maintain my drnnicile in suc state. At t e time of makinq this
declaratfon I ani a bona fide resident of the State of . My place of
abode vithin the State of Florida, if any, is as follows: Here st street address, city,
and county of place of abode in Florida.)
tPerson makinq declaration may also inclu3e 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.)
517156
1981 f~~ t I ~'~ ~~~ ~8
fIIEC tht ~• ~~`:si:~
S K~rR PCITRAS~
CIERK t1rC'J!1 C!~ ~ ' ~
F4 Cf.ftii VFR:%'' ~ ~~
signature
Sworn to and subscribed before me this day of. ,~-. D. 19
:totary ic State o F or a at Larqe.
!~y Commission expires .
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ao`~ 348 PaGE 2,r.~,z ~
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