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~ DECLARJITION O! DOMICxLE b~~~ ~
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To the C~erk of th~ Circuit Court [County Caaptraller] 7T County, Florida.
This is my declaration of doaaicile in the State of ~ , that I a~m filinq
this day in accordance and in conforinity With Section lor~da~tatutes.
P'OR DOMICILIARZES O! THE S~I~TE O! FLORIDA:
i her~by declar~ that I reside in and maintain a place of abode at 7~} 7 ~,a :,~,i ~#-~i7'•
s ree a nun~er~' ;
~ e C , in ~~J P County, Florida, Which place ot abode I
c3~yT
recoqnize and intend to maintain as my permanent hame and, i! I maintain another platce~or
places ot abode in sane other atate or states, Z hereby declare that my above-described ~
resid~act and abode in tha Stats of llorida constitutes my pradaeinant and principal haae, s
and I intend to continus it permanently as such. I am, at tha tf~a ot makinq this declara- '
tion, a boasa lide resident o~ the State of lloridn residinq at ~ , ,
, s ree ati n e
'r ~ ~ ~ ~C' , in ~ L~~1 ~ County, Flozida. I formerly resided at
'~C3~`Y
r c~ 1Yl County. St @ f 6 Y? Q$ nd the
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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~ Gf/`~ o~ •~i~ G r l L° GY , ~,f• L w C ~
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I took up pe~t residence in s~
/.i~Gi ~r~ ~ • C • _.~G~/Or l"~'G~~!~ ~p~t n~)
the state of Flarida on ~ (o
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. sign ur
~ L'i fr~ g , ~ ~'r' o.v (Print t~ame)
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Sworn to and subscribed before me this day of , A. D.. 19~. ~
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Notary Pu c State o or a a Large.
My Cc~qaission expiras
~ JAN 1~1 ~A9 :46
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~R.POITRA.S, QEHI~ G'IRCilIT OOURT ROGER t G~ ~ i-: z~;
~ ST. LUCIf Cl"~~ti' FL.
~ ~:'I~~.TC.'T.E OdCR~1I'Y ,
' • C. S?L38083
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FOR DOMICILI 0! ST1?TES O?HER THAN STATB OF FLORSOA:
I herer,Y declare t aiy danicile is in the S e of ,~/d,- and that I intend
to permanently continu nd maintain my domicile suc
sFi
a~te; ~ t-4ie-time of making this
declaration I am a bona e resident of the State - My place of
abode vithin the State of F ida, if any, is as follo ere ist street address, city,
and co ty of place of abode i lorida. ) a 7G ~ v~ 9~, ~~t /D ~r ~,•P~~ ~ s~; 1,~
~e
fPerson makin eclaration may also lude such other and fu er facts With reference to
any acts done or rfoz~ae~ by such pers which such person desi or intends not to be
construed as eviden any intention to e ahlish his daaici2e wft 'n the State of Fl~rida.)
ture
Swom to amd Subscribe3 befare me this day o , 9
Notary Public, State of Fl~rarida
~R453
BOIN( P1GE ~I~