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DECLARATION OF DQMICILE
To the Clerk of the Circuit Court (County Comptroller~ ST. Ll1CIE County, Florida.
This is my declaration of domfcile in the State of ~(2 1~/~ , that 1 am filinq
this day in accordance ar~d in confor~nity with Section ~~'Tor~da 3`tatutes.
FOR DOMICILIARIES OF THS STATE OF FLORID7-:
T hereby declare that I reside in and maintain a place of abode at ~3~ ~ ~ Wum~~•
s reet ana n er
~_~ , in ST. LIJC I E County, Florida, which place of abode I
c ty
recoqnize and intend to maintain as my permanent haae and, if I mafntain 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 n-y predominant and principal home,
and I intend to continue it permanently as such. I am, at the time of makinq this declara-
tion, a bona fide resident of the State of Florida residinq at ~+ 5 3~ .
~ G ( street an nu er
' ~~~~ ~ ~-~wt,C.t , in ~~ ~,C. County, Florida. I formerly resided at
(city) ~
1~ , .? ny,~~. . Cjv~,~,;.,~,s..,..~,County, _ ~w~, , and the
~ y state -
plnce or places where I maintain another or other place or places of abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.)
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gnature) .
Sworn to and subscribed before me this LZ day o~' , A. D. 19~.
ROGER PO I A S, CL ERK G I RCU I T COU2 T
ST. LUC I E C UNTY, FLOR I ~A
Notary PuriYic State of Florida at Large. `
My Comn~ission expires . BY DE P U T Y C L E R K
FOR DOMICII.IARZES OF STATES OTHER THAN THE STATE OF FLORIDiAs
ere ec are t at my omic le s.n the State of and that I intend
to permanently continue and maintain my damicile in such state. At the time of making this
declaration Z am a.Liona fide resident of the State of !~!y place of
abode ~ithin the ~tate bf Florida, ff any, is as follows: (Aere l~st 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 perfornied by such person whfch such person desires or intends not to be
construed as evidencinq any intention to establish his domicile Within the State of Plorida.)
51'~181
1981 FE~ 17 PE? 12~ 06
Fll: [ th~ •• ;:UFi~i G
SI. LL~~IC CG;1V 1Y.f; A_
ROGER PQ~TR.1S
CLERK ClECJ11 CLL'i:~
~'•: :•:r.~ ~ i I '. , (~~.
a
(signature)
sworn to and subscribed before me this
day of , A. D. 19 .
Notary Public State o~ FYorida at Larqe.
My Conunission expires -. .
~ ao' K 3~8 PAC~ ~56
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