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DECLARATION OF DOMICILE t
Ta the Clerk of the Circuit Court [County Cotnptroller) ST. LllC I E County, Florida.
mhis ia my declaration of doraicile in the State of ' , that I am filing
this day in accordance and in confonaity with Section or ~ tatutes. ;
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FOR Dal~lICILIARIES OF TAE 5~ATE OF FLORIDA: ~
I hereby declare that I reside in and maintain a place of abode at l~C~c'~hpill ftr/~. l~i~T ~11 ,
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r'~~ee ~~rT--
, ~r ~ . in ST. LIJC I E County, Florida, which place of abode I
(city
recoqnize and intend to maintain as my permanent ha~ae and, if I maintain another place~or
plnces of abode in some other state or states, I hereby declare that my? above-described
resideACe and abode in the State of Florida constitutes my predominant and principal hane,
and I intend to continue it permnnently as such. I am, at the time ~ki~g t~i,s ~~clara-
~ion, a bona fide resident of the State of Florida residing at ,s i~~, iQorJ'• ,
s e'f an nw er
p~er~P. , in Sf County, Florida. I formerly resided at
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a.cte~u: A_ , pe P~SoT~ County, , and the
c ty s ate -
place or places where 1 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.)
I BEtAME A RESIDENT ON THE OAY OF ~ 19 . ~
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Ss?orn to and subscribed before me this ~ a day of , A. D. 19
ROGER P01 TRAS, GLERK C IRGU I T COU2T i
ST LUC I E COUNTY, FLOR I OA
' Notary Pu c State o F ori a at Large. ~
~Sy Commission expires B Y ~ DE P U T Y C L E R K ;
; ,
~ r^OR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FI.URIDA: ;
~ a er y are t t my- c~e is n the State of and that I intend
'~o permanently-continue~ and~ maintain my dcxaicile ~n sue state. At t e time of making--t~i-s ~
~ declasation I am a bona fide resident of the State of Irly place of
~ abode within the State of Florida, if any, is as follows: Here ist street address,--city, ;
~ and county of piace of abode in Florida. )
~(~erson making declaration may also include such othez and further facts with referenc~ to
~n~ acts done or perfonned by such person which such person desires.or intends not to be
c~c.nstrued as evidencing any intention to establish his domicile ~ithin the State of i~lorida.)
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1981 t;~' ~ I 2 PN 2~ 2 6 '
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~Cu;~R PCiTRAS ~
- ' CLEFK CIRCilIT COURT
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Ri CGRO Rtf!ED
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~~,~,~orn to and subacribed before me this day of , A. D. 19
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~tary ! c State • ! •r at r~e.
=sy Conanission expires .
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