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51'7359
DECLARI-TION OF DOMICILE ~
To the Clerk of the Circuit Court [County Comptzollerl ST. Ll1CIE County, Florida.
This is my declaration of domicile in the State of ~ , that I am filinq
this day in accordance and in conformity with Section ., F or a tatutes.
FOR DOMICILIARIES OF THE S~ATE OF FLORID]-:
~ hereby declare that I reside in and maintain a place of abode at Jo2 N,~, ~ ~.Q~c~ ,
s ree an nu er -
f~~,~-~. ~c,c t~ , in ST~, LUC I E County, Florida, which place of abode I
tcity~
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 nty above-described
residence and abode in the State of Florida constitutes my predominant and principal home,
and I intend to continue it permanently as such. I am, at the time of makinq thfs d~ly~~-
tion, a bona fide resident of the State of Florida residinq at ~ a ~iy~c.~~i~-d ~ry ~4-'
D ~ (street ana numner~
~~~ ~• x.ut-~R- , in ~. ~~-~ County, Florida. I formerly resided at
Ccity) ~
-~ ~ , County, ec~1 , and the
city $ e ~
place or place where I maintain another or other place or places of abode are as follows:
(Here lfst street address, city, county and state of any other place or places of abode.)
. ~ ••.~~
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Sworn to a"nd subscribed before me this ~~
Nota*_y Pu~Yic State of FYorida at Larqe.
My Commission expires .
~`~~~~~~. ~ , ~ ' ,
~ C- ~r 1 U Q~~ S
siqnature) ~
day of , A. D. 19 g~.
ROGER PO I 1RA S, CL ERK C I RCU I T
ST. LUC 1 E COUNTY, FLOR I OA
B Y~ ~d~_D E P U T V
FOR DOlSICILIARIES OF STATES OTHER THAN THE STATE OF FLORIOA:
er y ec are t at my omicile is n the State of
to permanently continue and maintain my drnnicile in such state.
~eclaration Z am a bona fide resident of the State of
COURT
;
CLERK ~
and that I intend
At trie time of making this
abode vithfn the State of Florida, if any, is as follows: (Here tist
and county of place of abode in Florida.)
My place of
street address, city,
(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 damicile within the State of Florida.)
51'~359
1981 F; I 8 A!! ; t: 30
f~cf f tH[ F~COFIl; 0
~!! ~~cif c~u.ytY ~ ~ a.
R('~~~ f'OiiR~lS
~! t'r'.K C!~~U'I Cf~F.i~
~- f'
rslgnature)
,
sworn to and subscribed before me this
i •
day of , a-. D. 19 .
*~ctary Public State o~ FYorida at Larqe.
!~y Commission expires .
~~
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Bo~x 348 P~~ 2fi02
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