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/ DL?CI,J?R)1TION O! DOMICILB ~Q~ '
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t
County, Floridn. ~
To the Clerk of th~ Circuit Caurt [County CaaptrollerJ 0~-~-~-L
This is my declaration ot danicils in th~ State ot i~G- , that I am filinq
this day in accordance and in contormity with Section 3''f~T7; ~ oI-i3~a~3`tatutes.
FOR DaMICILII?RIES Ol~ THB S~ATS O! FLORIDA:
i hereby declars that I reside in and reaintain a place ot abode at 3.~ y,~~ X~ e~ a'? c+ Vl'-,
s ree an n er
~~L. ~,'.e rC ~ ~ in ~,c,~.F~
, County, Florida, which place of abode I
~c y ~
recoqnize and intend ta ~oaintain as my penaanent han~ and, it I maintain another place or ~
places of abode in aome other state or states, I hereby declare that my above-described
reaidenca and abode in the State of Florida cons~itutes my predominant and principal hame,
and I intend to continue it permanantly as such. I am, at the time of q~c inq this declara-
tion, a boaa fide resident of the State o! Florida residinq at 1~.' x; ~ l•~h a~ ~r' .
D s reet an n r
p~ C~ in ~~-p`,~~~1 o County, Florida. I fonaerly resided at
--rc y .
rk n~( le a. • ~'1 -r n~ County. C h. S~~"1 . and the
~ Y -Z"sta e ~
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.)
~
Q T!-', s~ c'c /•P X a n C~ ~ Y~ .
I took up pern~~ent reside~ice in ~ ~ ~ ~
~ ' (pr~nt name) -
the state of Flarida on 7- g~ • ~
signa ure
, (p~cint name) _
Sworn to and subscribed before me this ~ day of ~T~ h~ a?• y, A. D. 19~.
Notary Pu c tate o cr a at rqe.
t~ty_.~~aamnission expires ,~N ~4 A9:46
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~R ~'OITRAS , QERK CIRGIJIT OOURT ROGER ru; i:~
. R ST. LUCIE CC:ii~ i~. ~ L.
~ ~ S'T . :,~](~E 00[7NI'Y , F~I~IDA s~S~84
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F'OR CILIARIES O! STATES R THAN THE STATE OF FLOR
I hereby dec re that my danicile in the State of r v and that I intend :
t~ permanently ntinue and maintain domicile in suc state At t e time of making this %
d~claration I am na fide resident o he State of ,"C~/'1 My place of
at~ode within the Sta of Florida, if any, ' as follows: ere i t~treet address, city,
and co of place of e in Florida.) .
(Person mak declaration also include such o er and further facts th reference to
any acts done performed by ch person which such erson desires or inte s not to be
construed as evi cinq any inte ion to establish his omicile Within the St of Florida.)
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Sworn to and Subscribed befare me t I Y day of , 19~•
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I~btary Public, State of F~rida ~
ao`oz 453 Pe~E 9I~
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