HomeMy WebLinkAbout0939 t ' f/
~62638 1~
DECLARATION OF DOMICILE
To the Clerk of the Circuit Court (County Comptroller) ST'~ UC/C County, Florida.
This is my decia[ration of domfcile in the State of f~a~~r~~ , that z am filinq
thi~ day in accordance and in conformity with Section F or a tatutes. ;
FOR DOMICILIARIES OF THE STATE OF FLORIDA: ~
I hereby declare that I reside in and maintain a place of abode at ~a w~f~J'"~ D,e, •
.
~ ~ s ree an n er
~R~ Sr~ L ue i~ , in ~S7 • Lv ~C County, Florida, which place of abode I
city
recognize and intend to maintain as my 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 pzedominant and principal hame,
and I intend to continue it permanently as such. I am, at the time of makinq thfs declara-
tion, a bona fide resident of the State of Florida residinq at 3~R •t~-Gv. co,eFS A2 . ,
~d~T~ S~ • Lve ~ C , in • ST -~vC it County, Florida. Itfoei-merly resided at
city .
~-19VDE R hf ~ L L ,_~20 w/¢~ D County, ~.~OIZ 1 0/4~ , and the
city state -
place or places where I 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
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I took up pe~ient resid~ce in L/iv0~-l~~e ~~ie~~
the state of Florida an $-c~ 8" $1 . = tp~t nane
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signature
. L O v/ S D~ ~C3J9~~{~ .(print name
Sworn to and subscribed before me this day of , A. D. 19~.
~ ,~12? P 1:30
rrotary Public S±ate o F ori a at Large. ~
My Commission expires fILED t,:~L
. • ST. UCIE COUH~i
Y~FLK
~ ~ . : : . - 662638
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FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA:
I hereby declare that my domicile is in the State of and that I intend
to permanently continuE and maintain my domicile in suc state. At the time of makinq this
declaration I am a bona fide resident of the State of My place of
~ abode within the State of Florida, if any, is as follows: Here ist street address, city,
and county of place~ of abode in Florida.)
fPerson 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 evidencing any intention to establish.his domicile within the State of Fl~rida.)
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S w~orn to and Subscribed before me this day of , 19
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i~btary Public, State of Florida
436 P~~E 940 ~
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