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- D~clorotiarn o~' ~~~•~ Ci~isenship
TO Tl3I~ STATE AND OOUNTY TAB A88SSS01ti,
sT_ IACIB ~ OOUNTY.1~'LORIDA:
This is mY declaration of Domicile and CitisenaLip in the State of P7aeidu that I am !!ling this day in
accordance, and in conformity with Chspter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident oi___._~~~~---------_----- i~d
and I resided at___ - ~-~~~-----?'~~r3i~-~~~~a--Ss----------------------- ------. Iiowav~er, I Nava chaa~ed my domirale
t °.~rr! sue: ;it:,:.f::_
to and am and have been a bona 8de resident of the State of Florida-aim~e_-__-_- g3rQ_._-__._ ________day of
_Dsoe~ber___---___-- -____, 19~, and I reside at.___14E3_~o~i,i~..At~u+
------------------------
if3treet and Nnmbsr)
Port Pieroe 8t. Luoi~ ----____------___--- --___--County, Florida.
(cft,l _ - x --
and this statement is to be taken as my declaration of atizenahip, actual legal residence and domicile in
the State of -Florida. -
former domicflarr mo~nof tamitr to new domiWs. pn~rehw ~o~r;linQuiabmaat of amylormmt at
Entering three ohildr~n in publio aohool.
1- Eleanor Yarioa
E- 1Nayne Marion
3- Linda D[arion
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I FUftTHEB CERTIFY that I will register at my Iocal address when the registration hooka reopen,
and comply with all other requirements of a legal resident of ibis Stale.
~~~~~
I~~ ' ;~' -:~ ~~. 3:31
I r'u!i`1'tiF:K CEit'1`I1~=Y that I have no intention to return to my former tiomiciie, and I iniendto remain
• Port Piero St. Lucie ______--County, Florida,
m--------------- - ---- - ---------------------------------_______--------, -_-__----------------------------
(cft,l
permanently.
t (Name)
Sworn to and aub,~or`bp~re
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-ot~;:lht
My Co bn~i~c~l~E~.i;~
me this.-- 3__-_---day of
i~_. A. D. 19.41._.
(Address)
(To be ex~it~sd ~ itt • da=-1
~'owea BapDlr Co., P1.at Citr. ~•
at Lrs.
/63
and orisinal }fled with Aerit Cfr+euft Coot, and dnplfeat. with Ta~c Assessor)
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