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6~ J^-'~~ DECLARATION OF DOMICILF.
r~~ the C'.•°rk of the Circuit Court (County ComptrollerJ ,f . u~~iCy~~ County, Flori~a.
i
T!:is is r~y deciaration of domicile in the State of f~L~t.~,c~~v , that I am filiny
t:is da}~ ~n accorciance and in conformity with Section ~'f~:fT,
FTori3a Statutes. ~
~'OR DOMICI:.IAt<'lEJ OF THE STATE OF FLORIDA:
: here:~,~ de;.lare that I reside in and maintain a p~ace of abode at ~~FJt r~ ~~2~~c~ /9c'`L .
T.-
- ~a~.rt;~C dllu I1iii~u>ci /
~~~~?-L~ in ~~j~~~~~'i County, Florida, which place of at~ode I
(city •
-eco.,-nize and int~:nd to maintain as my permanent home and, if I maintain ano*_her place or
~laces of abode in some other state or states, I hereby declare that my above-described.
~esidence and abode in the State of Florida constitutes my predominant and principal home,
s:d I intend to continue it per.nanently as such. I am, at the time of makinq this eclara- ,
~ ior., a hona fide resident of the State of ~'lorida residir.g at 7y 0~ ~f ~.~~2Z~+~, ,
~street an num er')
, in County, Florida. I formerly resided at
(city
_J~ ~ • , ~{J~~~yL*..~~_,._~ Cour.ty, ~ , and the
l`c'ity ' state
~lace 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.)
;
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s i~att~e
~ t:~.~k u~ Ex~nr.~c~t residence in fc v f
f -(print name; '
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r`,~~ ~t~r.e of Florida an , ~ ~ ~ ~y - ~
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Sworn *o and subscribed before me this day of ~jy2f,~ , A. D. 19~.
v
; ':-.~tsry Public State o Florida at Large. a • t
; ~y Co:nmission expires ~ ~ ~v ~Ov~ ~
~r • .
FILE~ ~
t ROGEft FC ~ ' . . . : .~:r:
~ L;tY~:~ ~'F aS , 2E.R.I.' CIRCI'IT COLRT ST. LUt,lc = • .
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~ s~ . I.~;LT~: cxx~~~ , T~FUra b'73218
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~ T~ :)O~i?C~:.In . OF STATES OTHER THAN THE STATE OF ID?~:
~
~
~ _~~ereby d:.•clare that m omicile is in the St and thar_ I intend
~ -~~f~ermanent?y continue ar. intain m cile in suc state. At the time of m' this
~ __claration I aT a boza fide r of~the State of piace of
~ _~•ode wit~,ir ~7e State of ida, ' any, is as follows: Here is eet address, city,
_ ~;~d countv -~f place abode in Flori
~
~ =-ers .-in_7 declaratior may also include oth nd further facts wit ere:~.e t~
~ ~y acts done nr performad b; s~ch person which person desires or ' nds t to be
"astrued a~ evidencing any intention to es ish h or~icile wi the State o Fl~ri3a.)
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~r'~ F'~.blic, St~~tf~ o~ F1^ric:,.i t;; ~.:.c~~,~ i~. u~o.
a~~443 ~~~~E 981
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