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DECLARIITION OF DOMICILE
To the Clerk of the Circuit Court (County Caaptro2ler) ST. L UCIE County, Florida.
~ shis is my declaration of doiaicile in the State of f/o ;~o~~ , that I am filinq
this day in accozdance and in contortnity ~+ith Section ~~~IT; ~or~da $tatutes.
FOR DOMICILURIBS Of THE S~ATE OF !'IARIDA:
I hareby declare that I reside ia and maintaln a place of abode at s~ .
s ree an nu er
~j. ~e ~ e. , in ST. Ll1C i E County, Florida, wtYich place of abode I
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recoqnise and intend to maintain as my pex~nanent hane and, if I maintain another place or
~~~c=s o~ a~3e in sc~e other ~tata or atatea, I hereby dcclare that iay above-described
residance end abade in the State of !'lorida constitutes my predominant and pr~ncipal home,
and I intend to continue it penaanently as such. I aa~, at the time of makinq this declara-
tian, a bona fide resident o~ the S~ate of l~lorida residinq at t1d o8 K~.
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~s
r~ee an nun r'f"
,'c ~ c~ , in T. L c~ i_ County, Florida. I fo~ resided at
'~-Tc3~~
' . 'L i v~'s To~t county, _~~t~ yei~/r. , ana the
~ Y stat , :
place or places where I maintain another or other place or placea of abode ~a~+a:
(aere list street addreas, cfty, county and state of any other place or,p ~
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I BECAME A RES I ~ENT ON THE DAY OF . 19~_ ~.s .
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~a-JVe]~ M. Su/~~,~~ :3rt!, ~f~iy ~ y ~
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is qna ure
S'~rorn to an~ subscribe~ before me this.3 ~ day of ~ D. 19~.
ROG P01 TRAS, CLERK C IRCU I T COUi2T
ST. LUGIE COUNTY, FLCRIOA
Natary c Stste o F or a at La~c~ge. .
l~ly Coa~ission expires~ . B E P v T tr C L E R K
~ F+OR DOMICILIARZES OF STATES OTHER TH]~1 T~ STATE OF FLORIQA:
~ _ s ~e_~*R _ t my e~c ~ th~e State of and that I inten~ '
to permanently pntlnue and maintain my danicile in suc state. t time of malcing this ~
declaration I am s bona fide resident ot the State of t4y place of
abode Mithin the ~5ta~e of Plo~ida, if any, ia aa tollows: ert st street ad6ress, city, '
and eounty of place of abode in Florida.)
(Person making declaration a~ay also include such other and further facts ~+ith referencP to
any acts done or performed by ~uch peraon whfch such person desirea or iatends aot to be
construed as evidencing any intention to establish his daaicile within the State of Florida.)i
I
~81 AUG 31 AN ~ 58
iILE-C t.NC «CORUfO
I 51 LUCIE CGUHTY.fLA
~ R~GER POtTRAS
CLERK ClRCUIT COURT
RECORO Vifi1FIE0
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i aiqnature
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; 3rorn to aad aubsaribed before me tlhie day of D. 19 .
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~ Notary c State o F or a at Larqe.
*!y C~mission expires .
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K~i'~, PA6E .
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