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DECLARATION OF DQMICILE
'ro the Clerk of the Circuit Court [Courity Caaptroller) ST. LUC I E Caunty, Plorida.
This is wy declaration ot danicil~ in the Stat~ of ~l(7~/ , that I aai filinq
this day in accordance and in confonnity with Section ~~~~~-$tatutes.
FOR DOMICILZARIES OF THE STATB OF FLORZ071:
I hereby declare that I zeside in and maintain a place of abode at ~j~~ ~//[~SC~ .
L- C) [ L~~L . in ST. LllC ! E Couaty, Florida, `+hichrplaa~ ofnabode I
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recoqnize and intend to maintain as my permanent hame and, if I maintair~ another plac~~oz
placea of abode in aaae other state oz states, I heraby dec2are that m~y above-describad
residence and abode in the State of Florida constitntes my pzcdcaninaat aad principal homa,
and I intend to continue it permanently as such. I as~, at the ti~ae t a kinq this declara-
tion, a bossa fide resident of the State of Florida residinq at .r ,
d S"f L , in ~t,~ ' a r~et an num ~er
c t~~ t_~ ~~~b ~p~,~n~'y ~°unty, Florida. I~ormezly reaided at
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place or placea Where I maintain another or othez p~ace or places of abode are as tolla+s:
(Aere 2ist street address, city, county and state of any other place or placea of abode.)
I BECAME A RESIOENT ON THE ~,~DAY OF ~ 19_,$~.
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Sworn to and subscribed before me this (D day of , 1~. D. 19~.
ROGER P01 TRAS, CLERK C IRCU I T COURT
~ ST. LUCIE COUNTY, FLORIOA
Notary Pu c State o F or a at Larqe. ~
j ~ Cammission expires BY DEPUTY CLERK `
~ FOR DOMICSLIARIBS OF STATES OTHER TH71N TAE STATE OF FLORZLI~:
er ec are t my c e s State of and that I intend
~ ~a permanently cantinue and maintain my doanicile in suc state. t e tfine of makfnq this
declaration I am a bona fide reaiden~ of the State of . My place of
abode ti?ithin the State of Florida, if any, is as follows:'~; ere st street address, cfty,
and couaty of place of abode in Florida.) .
(person making declaration may also include auch other ar~d further facts Mith reference to
any acts done or perfonoed by auch person ahich such person desires or intends not to be
constru~ed as evfdencinq aay intention to establish~his damicile irithin the State of Florida.)
544~ ~
1981 OCT -6 ~ i~ i 7
r~~ tM :''n*..Ci 0
S•'~ ~,c ~L,;~;Y.iii~
Ft:~LR PCITRAS
CLEFK Uf~~UIT COURi
~ + ~ECC,R01'EntftLO
signature
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Sworn to and subsczibed before me this day of , A. D. 19 ~
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Notary P ic State o F or at Larqe.
!~y Coma~?ission expires
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