HomeMy WebLinkAbout0960 s
~ /
~ s4szos ~
DECLARATION OF DOMICILE
~c the Clerk of the Circuit Court (County Comptrollerj ST. L UCIE County, Florida.
This is my declaration of domicil~ in the State of Floricla , that I am filfng
this day in accordance and in conformity with Section F ori a tatutes. ~
~
FOR DQMICILIARIES OF THE STATE OF FLORIDA: '
I hereby declare that I reside in and maintain a place of abode at I302 S.~ . L~-Y'~ ~
.
stree an n er '
~ , in ST. LUC I E County, Florida~, which place of abode I
city i
recoqnize and intend to maintain as n~y permanent home and, if I maintain another place or
places of abode in some other state or states, I hereby declare that my above-described `
residence and abode in the State of Florida constitutes my predominant and principal hane, ~
and Z intend to continue it permanently as such. I am, at the time of makinq this declara-
tion, a bona fide resident.of the State of Florida zesidinq at _ ,
street an n r
, in _ County, Florida. I formerly resided at
city. ~
, _ County, - ~ . - , and the
city state
olace or places where I maintain a.-~other or other place or places of abode. are as follows:
(Here list street addre~s, city, county and state of any other place or places of abode.)
I BECAME A RESIDENT ON THE DAY OP ~ 19 - .
.~r • ~
~ ; ~ ~
~
• - ~ ~
; ~ ~
~ '
~;,L~~ • i~". .y ~ s, -
• ' ~ ^ ~ '
, .t~~'~ ~ i ' ~ ig atur~ I
' ~~~~y{
~ y; ~ e~;' . C. ~ ~
r
, .
~ Sworn tb.. , s~ribed before me this ~ day of ~ , A. D. 19 .
;
E ~ ROGER PU f TR~ S, CL ERK C I RCU I T COlk2 T
~ .
I . ST. LUC I E COUjVTY FLOR i ~p
*:otary Pu lic State o Flori a at Large. n
! ^~y Coms.ission expires BY L~ ~~~'1~.~DEPUTY CLERK
~ FCR DOMZCtLIARIES OF STATES OTHER THAN THE STATE OF FLORIDA: -
!
I.ereby declare that my omicile is in the State of and that I intend
; ~c permanently continue and maintain my domicile in suc state. At the time of making this
~ :?eclaration I am a bona fide resident of the State of . My place of
abade within the State of Florida, if any, is as follows: Here ist street address, city,
and county of place of abode in Florida.)
iPerson 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
~ c:,r.strued as evidencing any intention to establish his damicile within the State of Florida.)
~ ~
~ ~ 54620$
~
~ 19~1 C~rT 23 3: ZR
~
~ ~ ~ - ~
- , ~ ~ y ~ :
~ -`r~'~
; signature
t
~
'=:,orn to and subscribed before me this day of , A. D. 19
w .
i
F
~
~
s?;~tary Pub ic State of Florida at Larqe.
~ Co:nmission expires ~
~
i
t 8001~( c3U~ PAGE 9W
~