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DECLARIITION OF DOMICILE
To the Clerk of the Circuit Court [County Comptroller~ ST. Ll1ClE County, Florida.
Thia is my declaraticn of domicile fn the State of r~rOR ,,Pq , that I am filing
this day in accordance and in canformity with Section 2Z2.1?, Floric~a 3`tatutes.
FOR DOMICILIARIES OF THE STATS OF FLORIDI\:
1 hereby declare that I reside in and maintain a place of abode at ~tt l
street ,~~ ~ sE
an n -; ~f.
er
;,~ ~ s T_ ~ ~c_r f , in ST. ~11C I~ County, Florida, which place of abode I
~city)
recoqnize and intend to mafntain as my permanent home and, if I maintain another place ar
places of abode in some other state or states, I hezeby declare that my 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 making this declara-
tion, a bona fide xesident of the State of Florida residing at- ~_.~ .
stre an num r)
,~, ;~ ~~,c.. f . in _~: L,,~., F County, Florida. I formerly resided at
(city) ~
lit ,-zo.v/~ . ,~,a ~ L F ~~~ ~ ~, ., County. ! f' , and the
tcity) ' / (state)
place or places where I maintain another or other place o'r places of abode are as follows:
(xere list street address, city, county and state of any other place or places of abode.)
I BECA `E A RESIOENT ON THE ~~~ ~AY OF ~f,~. ~ 19~ .
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_ _ (signature)
Sworn to and subscribed before me this ~ day of _~ , A. D. 19 ~~ .
ROGER PO i A S, CL ERK C I RGU I T COUR T
ST. ~UCIE COUNTY, FLORIDA _
Notary Purilic State of FYorida at Large.
My Commission expires . BY~ ~ DE P U T Y G l E R K
~'OR DOMICZLIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
ere y dec are t at my omic le is in the State of and that I intend
to pern-anently continue and maintain my domicfle in suc state. At the time of making this
decl~aration I am a bona fide resident of the State of ~L~,c,~P . My place of
abode within the State of Florida, if any, is as folloWS: tHere~ist 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 evidencinq any intention to establish his domicile within the State of Florida.)
~ 51'74~38
1981 F~`; 19 P~- 12~ 13
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~r u er~~ ~l co~; fc
S?. IUCi[ GGJN ~ Y. F t~
RC~GER P~JITRA5
GIEFK CIfCl3~1 GL~ /~
r
(signature)
Sworn to and subscribed before me this
t~otary Public State of Florida at Larqe.
*~y Commission expires .
!
~ _
~~.~,,~~.~~,:; _..~_. ~ .._..~ _.~ . . . _- ~
day of
, A. D. 19 .
brlnK 348 PAGE ~;.O~,y ,
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