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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 ~ , that I am ffling
this day in accordance and in conformity with Section ., F ori a 5tatutes.
FOR DOMICILYARIES OF THE STATE OF FLORIDA:
i hereby declare that I reside in and maintain a place of abode at p j~, . ~~ s~,•
` ~stree an number)
, in ST. ~ UC1~ County, Florida, which place of abode I
city)
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-describecl
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 making this decla a-
tion. a bona fide resident of the State of Florida residinq at ~~~ .o h•~ •
• ~treet an n ~ r
~~, , in ~~.. `~,~.(` ~~ County, Florida. I formerly resided at
cit -~~ n ~ ~
- ~.~. . ~~]['~~ I1„[~ `- ('~ County, fl ~ . , and the
city ~ (state) ~
place 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.)
BECAME A RESI~ENT ON THE ~y~ ~AY Of ~~' {;~ ~ 19~L.
~ ~'r~~UNl
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Sworn to and subscribed before me this 1~ day of ~ , A. D. 19 O~.
ROGER PO i TRA S, CL ERK C I RCU I T COUR T
ST. LUC I E~OUNTY, FLOR I DA
Notary Public State of Florida at Large. /J -
My Commission expires . 8Y~`7 DEPUTY CIERK
FOR DOMICILIARZES OF STATES OTAER THAN THE STATE OF FLORIDA:
ere y eclare t at my domicile is in the State of and that I intend
4o permanently continue and maintain my domicile in such state. At the time of making this
declaration I am a bona fide resident of the State of My place of
abode within the State of Florida, if any, is as follows: (Here list street address, city,
and county of place of abode in Florida.)
(Person making 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 evidencing any intention to establish his domicile within the State of Florida.)
- C h~~ 1 ~. Si'7415
m~. l~ S Jo.> S.~v~.t ~h
f981 FE~ I g PN ~ 53
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SL~UC.IE COi~NiY.fl~.
' RCGER POfiRtiS
C~EitN C~~~L~~- t;~:r ~• ~
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(signature)
sworn to and subscribed before me this day of , A. D. 19 .
°:otary Public State of Florida at Large.
My Commission expires .
a~~x348 ~~~~2688
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